枸橼酸盐和肝素钠用于成人血液透析导管封管有效性的Meta分析  

The effectiveness of citrate lock versus heparin lock for central venous catheter in adult hemodialysis patients:a Meta-anlysis of randomized controlled trials

作　　者：韩新[1] 曹艳佩[2] 杨晓莉[2] 黄碧红[2] 袁立[2] 任崇[1] 

机构地区：[1]复旦大学护理学院,上海200032 [2]上海市复旦大学附属华山医院护理部

出　　处：《护理学杂志》2015年第21期88-92,共5页

摘　　要：目的评价枸橼酸盐溶液在成人血液透析导管封管中的效果。方法计算机检索NGC、Cochrane Library、Joanna Briggs Institute Library(JBI)、MEDLINE、EMbase、RNAO、PubMed、CBM、Web of Knowledge、CNKI及万方数据资源系统中关于经中心静脉导管血液透析患者应用枸橼酸盐和肝素钠封管的随机对照实验,同时筛检纳入文献的参考文献。2名研究者对文献进行质量评价并提取有效数据,采用RevMan5.0软件进行Meta分析。结果纳入11项研究(RCT),共1 016例患者。Meta分析结果显示,枸橼酸盐封管组导管相关性感染的发生率(P=0.03)、出血并发症的发生率(P<0.01)显著低于肝素钠封管组;但两者在溶栓治疗次数(P=0.96)、导管功能障碍所致拔管的发生率(P=0.95)、导管内血栓形成的发生率(P=0.94)及导管相关的住院率(P=0.34)方面比较,差异无统计学意义(均P>0.05)。结论采用枸橼酸盐溶液封管,可显著降低经静脉导管血液透析患者导管相关性感染的发生率、出血相关并发症的发生率。因此,推荐枸橼酸盐作为血液透析患者中心静脉导管的封管液。Objective To evaluate the effectiveness of citrate lock for central venous catheter in hemodialysis patients.Methods The NGC,Cochrane Library,Joanna Briggs Institute Library,MEDLINE,EMbase,RNAO,PubMed,CBM,Web of Knowledge,CNKI and Wanfang Data were searched to collect randomized controlled trials（RCTs）on using citrate lock and/or heparin lock for central venous catheter in adult hemodialysis patients.The quality of the studies was critically appraised and data were extracted by2 reviewers independently,and meta-analysis was conducted.Results A total of 11 RCTs were chosen,involving 1 016 patients.The results of meta-analysis demonstrated that when used for central venous catheter in hemodialysis patients,citrate lock could decrease the incidence rates of catheter-related infections（P=0.03）,and bleeding-related complications more effectively（P〈0.01）than heparin lock.However,the differences in counts of thrombolysis treatment（P=0.96）,rate of unplanned catheter removal due to malfunction（P=0.95）,incidence rate of catheter thrombosis（P=0.94）,and rate of catheter-related hospitalization（P=0.34）,were not significant between the two locks（P〉0.05 for all）.Conclusion As for hemodialysis patients with the central venous catheter,the application of citrate lock could significantly decrease the incidence rate of catheter-related infections and bleeding-related complications.Therefore,citrate lock is recommended for central venous catheter in adult hemodialysis patients.

关 键 词：血液透析导管 枸橼酸盐 肝素钠 封管 META分析 

分 类 号：R47[医药卫生—护理学]