经外周中心静脉置管与中心静脉置管临床应用效果的系统评价  

The Value of PICC and CVC Clinical Application: Systematic Reviews

作　　者：葛永春[1] 王尚前[1] 邵国安[1] 陈良英[1] 

机构地区：[1]新疆医科大学第五附属医院肿瘤外科,新疆乌鲁木齐市830011

出　　处：《中国全科医学》2011年第36期4187-4191,共5页Chinese General Practice

摘　　要：目的通过对国内所有已经发表的有关经外周中心静脉置管(PICC)与中心静脉置管(CVC)随机对照试验进行系统的评价,进一步分析这两种置管方法在临床中应用的利弊。方法采用Cochrane协作网提供的有关干预试验的研究方法,采用GRADE3.5.1软件对所有纳入的文献进行证据质量评价,采用RevMan5.1.2软件对所有数据进行Meta分析。结果 PICC单次置管成功率高于CVC,差异有统计学意义[RR=1.21,95%CI(1.01,1.45);P=0.04];PICC组导管感染率低于CVC组,差异有统计学意义[RR=0.33,95%CI(0.12,0.89);P=0.03];PICC组误入动脉的发生率低于CVC组,差异有统计学意义[RR=0.11,95%CI(0.03,0.49);P=0.004];而PICC组静脉炎的发生率高于CVC组[RR=4.17,95%CI(1.42,12.29);P=0.01];两组气胸、导管阻塞、导管脱出、导管尖端异位、导管口渗漏的发生率间差异均无统计学意义(P>0.05);置管时间、导管留置时间间差异亦均无统计学意义(P>0.05)。结论 PICC具有单次置管成功率高、并发症少、留置管时间长等优点,可以较广泛地应用于临床,但是本研究纳入的所有研究的质量级别较低,高级别的研究纳入后是否可以逆转本研究的部分结果不得而知,期待高级别的文献研究进一步证实。Objective To systematicly evaluate the randomly - chosen documents published in China about peripherally inserted central venous catheter （PICC） and central venous catheter （CVC） to further analyze the pros and cons of these two inserting methods in clinical application. Methods Use the intervention trial research methods provided by the Cochrane Collabo- ration net and GRADE3.5. 1 software to carry out quality evaluation on al] the evaluations existed in the documents. RevManS. 1.2 software was adopted to make Meta - analysis of all data. Results In terms of single catheter the success ratio of PICC was higher than that of CVC and the difference was statistically significant [ RR = 1.21, 95% CI （ 1.01, 1.45） ; P =0. 04] ; PICC catheter infection rate was lower than CVC group, [ BR =0. 33, 95% CI （0. 12, 0. 89） ; P =0. 03] ; The rate of havig been wrongly strayed into the artery in PICC group was lower than that in CVC group [ RR = 0. 11, 95% CI （0. 03, 0. 49 ） ; P = 0. 004 ] ; while an incidence of phlebitis in the PICC group was higher than that in the CVC group [ RR =4. 17, 95% CI （ 1.42, 12. 29） ; P = 0. 01 ] ; No significant difference was found between the two groups in the incidence of pneumothorax, catheter to detain time, the catheter obstruction, the catheter extrusion, catheter tip the incidence of ectopic, the conduit leakage （ P 〉 0. 05 ） ; Catheter rime between PICC and CVC showed no statistical difference in need （ P 〉 0. 05 ） . Conclusion This study found that PICC had such good points as high success rate of single catheter, fewer complications, long time of tube indwelling and so on, which could be more widely used clinically, however all the documents included for this study analysis were of low quality, so it was unknown about the adaptability of high level of research to be involved in in the future, and we look forward to further confirmarion.

关 键 词：经外周中心静脉置管 中心静脉置管 系统评价 

分 类 号：R654.3[医药卫生—外科学]