肿瘤患者PICC与VPA临床应用比较的Meta分析  

Metaanalysis for the comparison of clinical application of PICC and VPA for patients with tumor

作　　者：阮叶[1] 顾迪[1] 高雪娟[1] 谢君雯[1] 董人平[1] 徐斌[1] 

机构地区：[1]江苏省常州市第一人民医院肿瘤科,江苏常州213003

出　　处：《护士进修杂志》2015年第17期1559-1562,共4页Journal of Nurses Training

摘　　要：目的比较经外周静脉穿刺中心静脉置管（PICC）与植入式静脉输液港（VPA）在恶性肿瘤患者中的应用效果及利弊，拟确立两种方法各自的适用人群。方法由两位独立评价者按检索策略检索中国生物医学文献库、中国期刊全文数据库、Medline等资源中已发表及未发表文献，研究人群为中国人。根据纳入标准筛选相关研究，评价研究质量后用Stata12．0软件进行分析，分析指标为并发症、首次置管成功率及置管时间。结果共纳入12项研究，总病例数1228例。结果显示：恶性肿瘤患者使用VPA长期静脉输液并发症发生率显著低于PICC患者[OR=0．25，95％CI（0．17～0．36），P〈0．01]，VPA患者组管路堵塞移位的发生率显著高于PICC组EOR=2．03，95％CI（1．04～3．97），P=0．037]，静脉炎及局部感染发生率显著低于PICC组EOR=0．49，95％CI（0．25～0．96），P=0．037]；VPA组患者首次置管成功率低于PICC组[OR=0．68，95％CI（0．41～1．13），P=0．138]；VPA组留置时间超过一年的患者显著多于PICC组[OR=39．11，95％CI（14．32～106．84），P〈0．01]。结论采用VPA长期静脉输液较PICC具有更低的并发症发生率、更长的留置时间，但VPA一次置管成功率较低，综合考虑，更适合一年以上长期静脉输液的患者应用。Objective To compare the application effect, advantages and disadvantages between peripheral vein puncture central venous catheter （PICC） and implantable venous port （VPA） for patients with tumor. Method Randomized controlled trials were collected from different databases according to inclusion and exclusion criteria by two independent researchers. Meta analysis was performed by Stata 12.0 software after quality evaluation of the articles, and the evaluation indexes were complications, success rate and time. Result 1228 patients from 12 randomized clini- cal trials were included. The results showed that malignant tumor patients with long term use of intravenous infusion by VPA in the incidence of complications were significantly lower than that of PICCEOR = 0.25,95 %CI （0.17 -0.36）, P〈0. 001]. The incidence of catheter occlusion and displacement in the VPA group was significantly higher than that of PICC group [OR=2.03,95%CI（1.04-3.97） ,P=0. 037], and the incidence of Phlebitis and local infection in the VPA group was significantly lower than that of PICC group[-OR= 0.49,95 % CI（0. 25-0.96）, P= 0. 037]. Intubation success rate for the first time in the VPA group was lower than that of PICC group[OR=0.68, 95%CI（0.41-1.13） ,P=0. 138]. The patients with piping indwelling time more than a year in the VPA group was significantly more than PICC group[OR=39.11,95 %CI（14.32-106.84）,P〈0. 001]. Compared with PICC, long term Conclusion Compared with PICC, long term intravenous infusion using VPA has a lower incidence of complications, however a lower intubation success rate for the first time, and more suitable for long term intravenous infusion over one year.

关 键 词：肿瘤患者 植入式静脉输液港 经外周静脉穿刺中心静脉置管 META分析 

分 类 号：R-05[医药卫生]