血液透析患者中心静脉导管发生相关血流感染危险因素的Meta分析

doi:10.3761/j.issn.0254-1769.2021.10.006

摘要/Abstract

摘要：

目的通过Meta分析了解留置中心静脉导管的血液透析患者发生导管相关血流感染的危险因素。方法计算机检索中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science、Embase数据库,检索时限为建库至2020年12月31日,使用RevMan 5.3进行Meta分析。结果共纳入20篇文献,包括29项相关危险因素,有统计学意义的危险因素包括合并糖尿病（OR=2.55）、血清白蛋白<30 g/L（OR=2.35）、CD4+细胞<200个/μl（OR=3.02）、急性生理与慢性健康评分Ⅱ≥20分（OR=2.41）、股静脉置管（OR=1.94）、导管留置时间≥14 d（OR=3.20）、使用带隧道带涤纶套导管（OR=2.83）。结论合并糖尿病、低血清白蛋白、CD4+细胞<200个/μl、急性生理与慢性健康评分Ⅱ≥20分、股静脉置管、导管留置时间≥14 d、使用带隧道带涤纶套导管是留置中心静脉导管的血液透析患者易发生导管相关血流感染,护理人员应充分关注该类患者。

关键词: 血液透析, 中心静脉导管, 导管相关血流感染, 危险因素, Meta分析, 循证护理学

Abstract:

Objective To clarify the risk factors of catheter-related bloodstream infection in hemodialysis patients with indwelling central venous catheter through meta-analysis. Methods We searched databases including CNKI,Wanfang,VIP,CBM,Cochrane Library,PubMed,Web of Science and Embase from inception to December 31,2020. Rev Man 5.3 software was used for meta-analysis. Results A total of 20 articles were included,including 29 related risk factors. The statistically significant risk factors were diabetes（OR=2.55）,serum albumin <30 g/L（OR=2.35）,CD4+ cells <200 cells/μl（OR=3.02）,APACHE Ⅱ score ≥20 points（OR=2.41）,femoral vein catheterization（OR=1.94）,catheter indwelling time ≥14 days（OR=3.20）,and tunneled cuffed catheters（OR=2.83）. Conclusion Risk factors for catheter-related bloodstream infections in hemodialysis patients with indwelling central venous catheters included diabetes,low serum albumin,CD4+cells<200 cells/μl,APACHE Ⅱ score≥20 points,femoral venous catheterization,catheter indwelling time ≥14 days,and tunneled cuffed catheters.

Key words: Hemodialysis, Central Venous Catheters, Catheter-Related Bloodstream Infection, Risk Factors, Meta-Analysis, Evidence-Based Nursing

林丽玉, 许丽春, 张鑫, 钟玉凤. 血液透析患者中心静脉导管发生相关血流感染危险因素的Meta分析[J]. 中华护理杂志, 2021, 56(10): 1478-1484.

LIN Liyu, XU Lichun, ZHANG Xin, ZHONG Yufeng. Risk factors of central venous catheter-related bloodstream infection in hemodialysis patients:a meta-analysis[J]. Chinese Journal of Nursing, 2021, 56(10): 1478-1484.

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