直型与卷曲型腹膜透析导管相关并发症和导管生存率的meta分析  

Comparison of coiled versus straight end peritoneal dialysis catheters on complication incidence and catheter survival: a meta analysis

作　　者：邱辉[1,2] 洪敏[1] 张德伟[1] 郑红光[1] 

机构地区：[1]沈阳军区总医院肾内科,沈阳110840 [2]郑州人民医院颐和医院,郑州450047

出　　处：《中国血液净化》2014年第10期689-694,共6页Chinese Journal of Blood Purification

基　　金：全军十二五重点课题;BSY13C002

摘　　要：目的 腹膜透析是治疗终末期肾脏病的有效方法,良好的腹膜透析导管功能是其技术成功的关键.本项meta分析的目的是对比直型与卷曲型腹膜透析导管的临床预后.方法 综合检索PubMed（1990 to Sept2013）,Embase（1990 to August 2012）,CNKI（1990 to Sept 2013）和CENTRAL（theCochrane Library 2013）数据库,文章的参考文献进行手工检索.按照种族进行亚组分析.比较直管和卷曲管在导管移位、渗漏、感染、1年及2年技术生存率等10项临床指标发生情况.结果 共纳入11项RCT研究,共843例患者,在10项临床观察指标中,直管和卷曲管仅在导管移位发生率有统计学差异（9项RCT研究和685例患者,OR,2.33;95％ CI 1.46～3.71;P=0.0004）,亚组分析结果显示亚洲人群卷曲管导管移位发生率明显高于直管（5项RCT研究和422例患者,OR 2.96,95％ CI 1.59 to 5.51;P=0.0006）,而欧洲人群两者之间差异无显著性意义（OR 1.65,95％ CI 0.80～3.40;P=0.18）.在机械相关其他并发症、感染相关并发症以及1年和2年的导管技术生存率方面,卷曲管与直管均无统计学差异,且不存在种族差异.结论 亚洲人群中卷曲管的导管移位发生率明显高于直管,但欧洲人群则无显著性差异,提示直管可能更适合于亚洲人应用.Objective Peritoneal dialysis （PD） is an effective treatment for end stage renal disease.A well-functioning catheter is the key to successful PD.We conducted a meta analysis of the literature to compare the clinical outcome of the patients using coiled versus straight end PD catheters.Methods Comprehensive search relevant to the outcome of coiled or straight end PD catheter was carried out in PubMed,Embase,Springer,CNKI,VP,CBM and CENTRAL （the Cochrane Library） published up to September 2013.Reference lists were searched manually.The methodology was in accordance with the Cochrane handbook for interventional systematic reviews,and the reporting of meta analysis was written based on the PRISMA statement.The quality of the studies was assessed,and data were extracted.The results were summarized as odds ratios （ORs） for dichotomous outcomes.We also carried out a subgroups analysis based on ethnicity.Results In this meta-analysis,11 randomized controlled trials with 843 patients were identified.In the 10 clinical observation parameters,only catheter tip migration had significant difference between coiled versus straight end PD catheters （based on 9 trials and 685 patients：OR 2.33; 95％ CI 1.46-3.71; P=0.0004）.Subgroup analysis revealed that coiled end catheters were associated with the increased risk of catheter tip migration in Asians （based on 5 trials and 422 patients：OR 2.96; 95％ CI 1.59-5.51; P=0.0006）,but not in Europeans.There were no significant differences in mechanical related complications,infection related complications,and one and two years of technical catheter survival rate between the two groups and different races.Conclusions Displacement of coiled end PD catheters was significantly higher than that of straight end catheters in Asians,but not in Europeans.Hence,straight end catheters should be more suitable for Asians.

关 键 词：腹膜透析 腹膜透析导管 并发症 META分析 

分 类 号：R459.5[医药卫生—治疗学]