中长导管与PICC导管相关性静脉血栓发生率比较的Meta分析

doi:10.3761/j.issn.0254-1769.2024.04.005

摘要/Abstract

摘要：

目的比较中长导管和PICC在导管相关性静脉血栓发生率的差异。方法检索中国知网、万方数据库、维普数据库、Web of Science、PubMed、Embase、Cochrane Library中关于患者应用中长导管与PICC导管相关性静脉血栓发生率的随机对照试验、队列研究，检索时限为建库至2022年12月31日。使用Review Manager 5.4软件和Stata 14.0软件对结局指标进行Meta分析与描述。结果共纳入16项研究，队列研究12项，随机对照研究4项，包括21 853例研究对象。Meta分析结果显示，中长导管、PICC的每千导管日的导管相关性静脉血栓发生率比较，差异具有统计学意义[RR=2.74，95%CI（1.21，6.21），P=0.016]；中长导管、PICC的导管相关性静脉血栓发生率比较，差异无统计学意义[RR=0.85，95%CI=（0.70，1.03），P=0.101]。在亚组分析中，中长导管、PICC的浅静脉血栓发生率比较，差异具有统计学意义[RR=2.36，95%CI=（1.56，3.58），P<0.001]。结论中长导管的导管相关性静脉血栓发生率高于PICC。故在临床实践中，应合理选择血管通装置，重视导管相关性静脉血栓的发生和发展，在充分评估的基础上有效开展临床筛查。

关键词: 中长导管, 经外周静脉置入中心静脉导管, 静脉血栓栓塞, 导管相关性静脉血栓, Meta分析, 循证护理学

Abstract:

Objective To compare the incidence of catheter-related venous thrombosis between midline catheters and peripherally inserted central catheters. Methods Randomized controlled trials and cohort studies on the incidence of venous thrombosis associated with midline catheters and PICC catheters were searched from CNKI，Wanfang database，VIP database，Web of Science，PubMed，Embase and Cochrane Library from inception to December 31,2022. Review Manager 5.4 software and Stata 14.0 software were used to analyse and describe the outcome indicators. Results A total of 16 studies were included，including 12 cohort studies and 4 randomized controlled studies，with 21853 subjects. The results of the Meta-analysis showed that the incidence of catheter-related venous thrombosis per thousand catheter days of midline catheters was statistically significant compared with PICC[RR=2.74，95%CI（1.21，6.21），P=0.016]. There was no significant difference in the incidence of catheter-related venous thrombosis compared with PICC[RR=0.85，95%CI=（0.70，1.03），P=0.101]. In the subgroups，the incidence of superficial vein thrombosis in the midline catheter was significantly different from that in the PICC[RR=2.36，95%CI=（1.56，3.58），P<0.001]. Conclusion The current evidence shows that the incidence rate of catheter-related venous thrombosis per thousand catheter days and superficial vein thrombosis was higher for midline catheters than PICCs. Therefore，in clinical practice，vascular access devices should be selected reasonably，and the occurrence and development of catheter-related superficial venous thrombosis should be paid attention to，and clinical screening should be effectively carried out on the basis of a full evaluation.

Key words: Midline Catheter, Peripherally Inserted Central Catheter, Venous Thromboembolism, Catheter-Related Venous Thrombosis, Meta-Analysis, Evidence-Based Nursing

贺文静, 王丹丹, 王文, 杨旭红, 沈犁, 赵文静. 中长导管与PICC导管相关性静脉血栓发生率比较的Meta分析[J]. 中华护理杂志, 2024, 59(4): 416-524.

HE Wenjing, WANG Dandan, WANG Wen, YANG Xuhong, SHEN Li, ZHAO Wenjing. Common incidence of catheter-related venous thrombosis between midline catheter and peripherally inserted central catheter：a Meta-analysis[J]. Chinese Journal of Nursing, 2024, 59(4): 416-524.

图/表 7

图1 PubMed检索策略

Figure 1 Search strategies of PubMed

图2 纳入文献流程图

Figure 2 Flow chart of literature search

表1 纳入文献的基本特征（n=16）

Table 1 Characteristics of the included studies（n=16）

表2 随机对照研究的质量评价结果（n=4）

Table 2 Methodological quality assessment for the included RCTs（n=4）

表3 队列研究的质量评价结果（n=12）

Table 3 Methodological quality assessment for the included cohort studies（n=12）

图3 2种静脉血管通路装置的导管相关性静脉血栓发生率Meta分析森林图

Figure 3 Forest plot of the incidence of CRVT in a meta-analysis of 2 types of venous access devices

图4 2种静脉血管通路装置的每千导管日导管相关性静脉血栓发生率Meta分析森林图

Figure 4 Forest plot of the incidence of CRVT per thousand catheter days in a meta-analysis of 2 types of venous access devices

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