国内成人肿瘤患者PICC相关性血栓发生率的Meta分析

doi:10.3761/j.issn.0254-1769.2022.03.016

摘要/Abstract

摘要：

目的系统评价国内成人肿瘤患者PICC相关性血栓的发生率。方法计算机检索PubMed、Embase、The Cochrane Library、Web of Science、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,收集关于国内成人肿瘤患者PICC相关性血栓发生率的文献,检索时限为建库至2021年5月。2名研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险后,采用Stata 14.0软件进行Meta分析。结果共纳入23篇文献,包括15 066例肿瘤患者。Meta分析结果显示,国内成人肿瘤患者PICC相关性血栓的发生率为8.82%[95%CI（5.93%~12.18%）]。亚组分析结果显示,发表年份为2019年—2021年的文献、年龄≥60岁、BMI>25、穿刺静脉为头静脉、穿刺方法为传统方法、穿刺次数>1次、导管规格为5 Fr、肺癌、肿瘤分期为Ⅲ~Ⅳ期、合并糖尿病、有PICC置管史、有静脉血栓史、置管前纤维蛋白原 ≥4 g/L、置管前D-二聚体≥0.5 mg/L的患者PICC相关性血栓发生率更高。结论成人肿瘤患者PICC相关性血栓的发生率较高,医护人员应重视高危患者的早期筛查和相关预防工作。

关键词: 肿瘤, 经外周置入中心静脉导管, 静脉血栓, 危险因素, Meta分析, 护理

Abstract:

Objective To systematically review the incidence of peripherally inserted central catheter（PICC）-related thrombosis in Chinese adult cancer patients. Methods PubMed,Embase,the Cochrane Library,Web of Science,CBM,CNKI,WanFang Data and VIP databases were electronically searched to collect studies on the incidence of PICC-related thrombosis in Chinese adult cancer patients from inception to May,2021. 2 reviewers independently screened the literature,extracted the data and assessed the risk of bias of included studies,and then the meta-analysis was performed by Stata 14.0 software. Results A total of 23 pieces of the literature involving 15 066 cancer patients were included. Meta-analysis results showed that the total incidence of PICC-related thrombosis in Chinese adult cancer patients was 8.82%[95%CI（5.93%~12.18%）]. Subgroup analysis showed that the incidence of PICC-related thrombosis was higher in the publication year from 2019 to 2021. The incidence was also higher in patients with age≥ 60 years old,BMI>25,cephalic vein puncture,traditional puncture method,the number of punctures more than 1,catheter size of 5 Fr,lung cancer,cancer stage of Ⅲ~Ⅳ,diabetes mellitus,history of PICC catheterization,history of venous thrombosis,fibrinogen content≥4 g/L before catheterization and D-dimer level≥0.5 mg/L before catheterization. Conclusions The incidence of PICC-related thrombosis in Chinese adult cancer patients is high,so health workers should pay more attention to early screening and prevention of high-risk patients.

Key words: Neoplasms, Peripherally Inserted Central Catheter, Venous Thrombosis, Risk Factors, Meta-Analysis, Nursing Care

李乾, 赵欣, 张晓维, 鲁华鹏, 贾蓓, 程言. 国内成人肿瘤患者PICC相关性血栓发生率的Meta分析[J]. 中华护理杂志, 2022, 57(3): 348-355.

LI Qian, ZHAO Xin, ZHANG Xiaowei, LU Huapeng, JIA Bei, CHENG Yan. Incidence of peripherally inserted central catheter-related thrombosis in Chinese adult cancer patients：a meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(3): 348-355.

图/表 5

图1 文献检索流程图

Figure 1 Flow chart of literature selection

表1 纳入文献的基本特征（n=23）

Table 1 Characteristics of the include studies（n=23）

表2 横断面研究质量评价结果

Table 2 Risk of bias assessment in cross-sectional studies

表3 队列研究质量评价结果（分）

Table 3 Risk of bias assessment in cohort studies（scores）

表4 国内成人肿瘤患者PICC相关性血栓发生率亚组分析结果

Table 4 Subgroup analysis of the incidence of PICC-related thrombosis in adult Chinese cancer patients

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