中等长度静脉导管不同尖端位置应用效果的Meta分析

doi:10.3761/j.issn.0254-1769.2025.08.016

摘要/Abstract

摘要：

目的评价中等长度静脉导管不同尖端位置的应用效果，为导管尖端定位提供循证依据。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中有关中等长度静脉导管不同尖端位置应用效果的研究，检索时限均为建库至2024年7月。由2名研究者独立筛选文献、提取资料并评价文献质量，采用RevMan 5.3软件进行Meta分析。结果纳入9篇文献，共2 302例住院患者。纳入文献质量均为B级。Meta分析结果：与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时，导管相关总并发症发生率、静脉炎、渗血、渗液、导管堵塞、导管脱出及导管相关性血栓发生率均较低，差异具有统计学意义（P<0.05）；中等长度静脉导管尖端位于锁骨下静脉时导管留置时间长于腋静脉，差异具有统计学意义（P=0.007）。描述性分析结果：与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时因并发症拔管率较低（P<0.05）。结论与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时，导管相关并发症发生率、因并发症拔管率较低，导管留置时间较长。未来仍需大样本、高质量的研究进一步验证中等长度静脉导管不同尖端位置的应用效果。

关键词: 中等长度静脉导管, 导管尖端, 并发症, Meta分析, 循证护理学

Abstract:

Objective To evaluate the effectiveness of different tip positions applied to midline catheters（MC） and provide evidence-based evidence for venous catheter tip positioning in clinical practice. Methods Computerized searches of PubMed，Web of Science，Embase，Cochrane Library，CINAHL，CNKI，Wanfang Database，VIP，and CBM for studies on the effectiveness of applying MC with different tip positions were performed from the time of database construction to July 2024. Meta-analysis was performed using Rev Man 5.3 software after 2 investigators independently screened the studies，extracted the information and evaluated the quality of the included studies. Results A total of 9 studies with 2 302 hospitalized patients were included. The quality evaluation results of the included studies are all B-level. Meta-analysis showed that when the tip of the MC was located in the subclavian vein compared with the tip of the MC in the axillary vein，the rate of total catheter-related complications，phlebitis，blood leakage，infiltration，catheter occlusion，catheter dislocation，and catheter-associated thrombosis were lower，with a statistically significant difference（P<0.05）. When the tip of the MC was located in the subclavian vein compared with the tip of the MC in the axillary vein，the catheter retention time was longer，with a statistically significant difference（P=0.007）. The descriptive analysis showed a lower rate of extubation due to complications when the tip of the MC was located in the subclavian vein compared with when the tip was located in the axillary vein（P<0.05）. Conclusion When the tip of the MC is located in the subclavian vein compared to when it is located in the axillary vein，the incidence of total catheter-related complications，phlebitis，blood leakage，infiltration，catheter occlusion，catheter dislocation，catheter-associated thrombosis，and the rate of catheter extractions due to complications were lower，and the catheter was left in place for a longer period of time. Due to the limitations of the quantity and quality of the included studies，more large-sample，high-quality studies are needed to further validate the effectiveness of different tip positions of MC.

Key words: Midline Catheter, Catheter Tip, Complications, Meta-Analysis, Evidence-Based Nursing

盛婉婷, 王蕊, 赵玉晓, 戚鹏菲, 高祀龙, 冯娟, 吕伯瀚, 牛群, 王刚. 中等长度静脉导管不同尖端位置应用效果的Meta分析[J]. 中华护理杂志, 2025, 60(8): 990-997.

SHENG Wanting, WANG Rui, ZHAO Yuxiao, QI Pengfei, GAO Silong, FENG Juan, LÜ Bohan, NIU Qun, WANG Gang. The effectiveness of applying different tip positions of midline catheters：a Meta-analysis[J]. Chinese Journal of Nursing, 2025, 60(8): 990-997.

图/表 5

表1 文献检索式

Table 1 Search strategies of studies

图1 文献筛选流程

Figure 1 Flow diagram of study screening

表2 纳入文献的基本特征（n=9）

Table 2 Basic characteristics of included studies（n=9）

表3 纳入非随机干预性研究的质量评价结果（n=7）

Table 3 Quality evaluation results included NRS（n=7）

表4 中等长度静脉导管相关并发症发生率Meta分析及亚组分析结果

Table 4 Summary of Meta-analysis results on the incidence of MC related complications

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