肿瘤化疗患者应用植入式静脉输液港与PICC效果比较的系统评价  

A systematic review on the effects of venous access port and PICC in cancer patients undergoing chemotherapy

作　　者：孙媛媛[1,2] 高伟[1] 崔英[3] 张红[1] 焦建芬[1] 李衎[2] 徐瑞彩[2] 

机构地区：[1]山东大学齐鲁医院PICC门诊,山东济南250012 [2]山东大学护理学院,山东济南250012 [3]邹平县妇幼保健院门诊,山东邹平256200

出　　处：《山东大学学报（医学版）》2015年第10期73-81,共9页Journal of Shandong University:Health Sciences

基　　金：山东省科技厅其他项目(26010104041413)

摘　　要：目的系统评价植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)在肿瘤化疗患者中的应用效果。方法检索Co-chrane Library、Joanna Briggs Institute Library、MEDLINE、EMbase、Web of Knowledge、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、万方数据资源系统及维普期刊资源整合服务平台(VIP)中关于肿瘤化疗患者应用VAP与PICC效果比较的随机对照试验、半随机对照试验、队列研究。由2位研究员按照纳入标准筛选文献、提取资料、评价质量,使用Rev Man 5.3软件对结局指标进行Meta分析与描述。结果共纳入5项随机对照试验、1项半随机对照试验、16项队列研究,共3 278例患者。Meta分析结果显示,VAP血栓发生率、导管相关性感染发生率均低于PICC[RR=0.31,95%CI(0.16,0.59);RR=0.39,95%CI(0.27,0.57)],但误入动脉发生率、气胸发生率均高于PICC[RR=8.70,95%CI(1.61,47.07);RR=6.12,95%CI(1.41,26.65)]。VAP患者生活质量B级以上的发生率较PICC高[RR=1.58,95%CI(1.38,1.82)]。描述性分析结果显示,VAP导管平均留置时间长于PICC。结论 VAP较PICC在延长导管留置时间、降低血栓及导管相关性感染发生率、改善肿瘤患者的生活质量方面具有优势,值得临床推广应用。但VAP置管过程中更应注意穿刺部位的解剖毗邻关系,以减少气胸及误入动脉的发生。Objective To evaluate the effects of venous access port（ VAP） and peripherally inserted central catheters（ PICC） on cancer patients undergoing chemotherapy. Methods The relevant randomized controlled trials,quasi-randomized controlled trials and cohort studies on the comparison of PICC and VAP were searched in databases including Cochrane Library,Joanna Briggs Institute Library,MEDLINE,EMbase,Web of knowledge,CBM,CNKI,Wan Fang Data and VIP. Data obtained were extracted according to the inclusion and exclusion criteria by two reviewers independently. The quality of included studies was evaluated. A Meta-analysis was conducted using Rev Man 5. 3 software.Results Altogether 5 randomized controlled trials,1 quasi-randomized controlled trial,and 16 cohort studies involving3,278 patients were included. The results of Meta-analysis showed that VAP was associated with a significantly lower incidence of thrombosis and catheter-associated infection than PICC[RR = 0. 31,95% CI（ 0. 16,0. 59）; RR = 0. 39,95% CI（ 0. 27,0. 57） ]. However,the incidence of the stray into the artery and pneumothorax was higher than PICC[RR = 8. 70,95% CI（ 1. 61,47. 07）; RR = 6. 12,95% CI（ 1. 41,26. 65） ]. Patients quality of life was higher afterVAP than PICC [RR = 1. 58,95% CI（ 1. 38,1. 82） ]. The descriptive analysis showed that VAP had longer catheter indwelling time than PICC. Conclusion VAP has advantages in prolonging catheter indwelling time,decreasing the incidence of thrombosis and catheter-associated infection,and improving patients quality of life. Therefore,it is worth to be promoted in clinical practice. However,to perform VAP,special attention should be paid to the adjacent anatomical relations of the puncture site during catheterization process,in order to reduce the incidence of pneumothorax and stray into the artery.

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

分 类 号：R472.9[医药卫生—护理学]