肿瘤患者完全植入式静脉输液港导管相关性血栓形成危险因素的Meta分析

doi:10.3761/j.issn.0254-1769.2022.23.002

摘要/Abstract

摘要：

目的通过系统评价的方法分析肿瘤患者完全植入式静脉输液港（totally implantable venous access ports，TIVAP）导管相关性血栓形成的危险因素。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库和维普数据库，检索有关肿瘤患者TIVAP导管相关性血栓形成危险因素的病例对照研究和队列研究，检索时限均为建库至2021年8月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果共纳入22项研究，包括4项病例对照研究和18项队列研究，共10 526例患者。Meta分析结果显示，肿瘤临床分期Ⅲ~Ⅳ期[OR=3.06，95%CI（2.16，4.35），P<0.001]、胸壁静脉植入[OR=0.69，95%CI（0.53，0.89），P=0.005]、体重指数≥25[OR=1.95，95%CI（1.21，3.13），P=0.006]、肿瘤发生转移[OR=2.72，95%CI（1.38，5.38），P=0.004]、硅胶材质导管[OR=0.73，95%CI（0.56，0.95），P=0.020]、高凝状态[OR=2.69，95%CI（1.94，3.73），P<0.001]及糖尿病史[OR=0.50，95%CI（0.33，0.76），P=0.001]是肿瘤患者TIVAP导管相关性血栓形成的独立危险因素。结论输液港植入位置及其材质、肿瘤临床分期、肿瘤发生转移、体重指数、伴随高凝状态、糖尿病史为肿瘤患者TIVAP导管相关性血栓形成的影响因素。对具有以上影响因素的高危患者应加强临床护理，以降低导管相关性血栓发生率，改善患者临床预后。

关键词: 肿瘤患者, 植入式静脉输液港, 导管相关性血栓, 危险因素, Meta分析, 循证护理学

Abstract:

Objective Risk factors for catheter-related thrombosis in totally implantable venous access ports （TIVAP） in tumor patients were analyzed by systematic analysis. Methods Computerized retrieval of PubMed，EMbase，Web of Science，the Cochrane Library，CBM，WanFang Data，CNKI and VIP databases was carried out. Case-control studies and cohort studies about TIVAP catheter-related thrombosis risk factors in tumor patients were collected from the database establishment to August 2021. 2 researchers independently screened the literature，extracted data，and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan5.3 software. Results A total of 22 studies were included，including 4 case-control studies and 18 cohort studies，with a total of 10526 patients. The results of meta-analysis showed that tumor clinical stage[OR=3.06，95%CI（2.16，4.35），P<0.001]，implantation location[OR=0.69，95%CI（0.53，0.89），P=0.005]，body mass index（BMI）[OR=1.95，95%CI（1.21，3.13），P=0.006]，tumor metastasis[OR=2.72，95%CI（1.38，5.38），P=0.004]，infusion port material [OR=0.73，95%CI（0.56，0.95），P=0.020]，hypercoagulable state[OR=2.69，95%CI（1.94，3.73），P<0.001] and diabetes history[OR=0.50，95%CI（0.33，0.76），P=0.001] are independent risk factors for catheter-related thrombosis in tumor patients with TIVAP. Conclusion Current evidence shows that the location，material，tumor stage，tumor metastasis，BMI，concomitant hypercoagulability，and diabetes are independent risk factors for TIVAP catheter-related thrombosis in cancer patients. Clinical nursing care should be strengthened for high-risk patients with the above risk factors，in order to reduce the incidence of catheter-related thrombosis and improve the clinical outcomes of patients.

Key words: Cancer Patients, Totally Implantable Venous Access Ports, Catheter-Related Thrombosis, Risk Factors, Meta-Analysis, Evidence-Based Nursing

温萌, 豆欣蔓, 苗晓琦, 付仲霞, 柳正丽, 刘晶, 孙宥涵, 严俊. 肿瘤患者完全植入式静脉输液港导管相关性血栓形成危险因素的Meta分析[J]. 中华护理杂志, 2022, 57(23): 2825-2833.

WEN Meng, DOU Xinman, MIAO Xiaoqi, FU Zhongxia, LIU Zhengli, LIU Jing, SUN Youhan, YAN Jun. Risk factors for catheter-related thrombosis in cancer patients with totally implantable venous access ports：a Meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(23): 2825-2833.

图/表 5

图1 PubMed检索策略

Figure 1 PubMed retrieval strategy

图2 文献筛选流程图

Figure 2 Flow chart of literature search

表1 纳入研究的基本特征（n=22）

Table 1 Detailed characteristics of the included trials（n=22）

表2 纳入病例对照研究的偏倚风险评价结果（n=4，分）

Table 2 Methodological quality assessment for the included trials（n=4，score）

表3 纳入队列研究的偏倚风险评价结果（n=18，分）

Table 3 Methodological quality assessment for the included trials（n=18，score）

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