思乐扣对经上肢置入的中心静脉导管固定效果的系统评价  

Systematic evaluation for the fixation effect of Statlock for central venous catheter inserted through upper limb

作　　者：宋燕伶 何金爱[1] 邹晓春[1] 

机构地区：[1]暨南大学附属第一医院,广东广州510630

出　　处：《护士进修杂志》2016年第15期1415-1420,共6页Journal of Nurses Training

基　　金：广东省科技计划项目(编号:2014A020212218)

摘　　要：目的评价使用思乐扣进行经上肢静脉置入的中心静脉导管维护固定对导管相关性并发症发生率的影响。方法计算机检索Cochrane library、Pub Med、Embase、Medline、JBI循证护理中心图书馆、CBM等数据库收集关于思乐扣、胶条以及缝线三种经上肢静脉置入的中心静脉导管维护固定方法的随机或半随机对照试验,由两名研究员按照纳入和排除标准筛选文献并提取资料,参考Cochrane Handbook(5.1.0)的质量评价标准对文献质量进行评价,采用Rev Man 5.3软件对资料进行meta分析或仅进行描述性分析。结果共纳入13项随机或半随机对照试验,meta分析结果显示使用思乐扣对经上肢静脉置入的中心静脉导管进行固定与使用胶条相比能降低导管脱出[RR=0.25,95%CI(0.14,0.42),P<0.000 01]、导管移位、静脉炎发生率[RR=0.41,95%CI(0.22,0.73),P=0.003];与使用缝线相比能降低导管相关性感染[RR=0.18,95%CI(0.07,0.49),P=0.000 07]、局部皮肤感染发生率[RR=0.24,95%CI(0.16,0.37),P<0.000 01],而皮肤过敏发生率[RR=2.50,95%CI(1.17,5.36),P=0.02]则高于使用缝线。结论思乐扣的使用能降低经上肢静脉置入的中心静脉导管脱出、移位、静脉炎、导管相关性感染,但增加皮肤过敏发生率。临床中,护理人员应认识思乐扣有效的临床效果,推广使用思乐扣对经上肢静脉置入的中心静脉导管进行固定,减少导管相关并发症,减轻患者痛苦。Objective To evaluate the influence of the use of statlock on the catheter-related complications for patients with the upper extremity inserted central venous catheter. Methods Studies of randomized controlled trials and quasi-randomized controlled trials about three fixing methods, statlock, tapes and secure, on catheter-related corn plications in patients with the upper extremity inserted central venous catheter were searched in the Cochrane librar- y, PubMed, Embase, Medline, JBI Library and CBM. The studies were selected according to the inclusion and ex- clusion criteria by two reviewers, and the quality of included studies was evaluated according to Cochrane Handbook （5.1.0）. Meta analysis was conducted by using Revman 5.3 or only for descriptive analysis. Results Thirteen RCTs or Quasi-RCTs were included. Meta analysis indicated that the use of statloek was associated with a significantly fewer incidence of catheter dislodgment[RR=0. 25, 95 %CI（0. 14,0.42）, P〈0. 00001], catheter migration and phlebitis[RR=0.41, 95%CI（0.22,0.73）, P=0.0033 than the use of tapes. The use of statlock was associated witha significantly fewer incidence of catheter-related bloodstream infection ERR = 0. 18, 95%0 CI （0. 07, 0. 49）, P = 0.000073 and local-skininfection[RR=0.24, 95%CI（0. 16,0.37）,P〈0.00001] than the use of secure. And the incidence of skin hypersensitivity was higher than the use of secure. Conclusions The use of statlock for patients with the upper extremity inserted central venous catheter performed better in reducing the rates of catheter dislodgment, migration, phlebitis, CRBSI and local-skin infection, however, with higher rate of skin hypersensitivity. Nurses should understand the effective result of statlock which can be widely used in clinical to reduce the catheter-related complications and to relieve the sufferings of patients.

关 键 词：中心静脉导管 思乐扣 固定方法 系统评价 

分 类 号：R472[医药卫生—护理学]