中心静脉置管后生理盐水与肝素钠盐水冲管效果的Meta分析  

Flushing effects of normal saline and heparin saline after central venous catheterization:a meta-analysis

作　　者：温尊甲 沈梅芬[2] 张海英[2] 刘巧艳[1] 王濯 

机构地区：[1]苏州大学护理学院,苏州215002 [2]苏州大学附属第一医院,苏州215002

出　　处：《中国循证医学杂志》2017年第1期58-64,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价生理盐水(normal saline,NS)与肝素钠盐水(heparin saline,HPS)在中心静脉置管后的冲管效果。方法计算机检索Pub Med、EMbase、The Cochrane Library(2015年12期)、CBM、CNKI、VIP和Wan Fang Data数据库,搜集NS和HPS静脉冲管效果的随机对照试验(randomized controlled trial,RCT),检索时限均为从建库至2015年12月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行统计分析。结果共纳入12个RCT,包括2 092例患者。Meta分析结果显示,NS组和HPS组在堵塞率[OR=1.58,95%CI(0.79,3.14),P=0.19]、导管平均留置时间[OR=–7.24,95%CI(–22.90,8.41),P=0.36]上无明显差异,在减少静脉炎的发生率上,HPS组优于NS组[OR=2.57,95%CI(1.52,4.34),P=0.000 4]。亚组分析表明,外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)中HPS组堵管率优于NS组[OR=1.85,95%CI(1.22,2.80),P=0.004],而NS组与10 U HPS和100 U HPS组在减少堵塞率上无明显差异[10 U:OR=1.51,95%CI(0.94,2.43),P=0.09;100 U:OR=1.51,95%CI(0.63,3.60),P=0.09]。结论 HPS在中心静脉置管后冲管效果可能优于NS,但尚需后续的RCT作进一步探讨。Objective To evaluate the flushing effects of normal saline （NS） and heparin saline （HPS） after central venous catheterization. Methods We searched PubMed, EMbase, The Cochrane Library （Issue 12, 2015）, CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials （RCTs） on the flushing effects of NS versus HPS after central venous catheterization from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 12 RCTs involving 2 092 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in occlusion rate （OR-1.58, 95%CI 0.79 to 3.14, P=0.19） and the catheter days （OR=-7.24, 95%CI -22.90 to 8.41, P=0.36）, while the HPS group had more advantage than the NS group in decreasing the incidence of phlebitis （OR=2.57, 95%CI 1.52 to 4.34, P=0.000 4）. Subgroup analysis revealed that HPS provided more superiority over NS in lessening the occlusion rate （OR=1.85, 95%CI 1.22 to 2.80, P=0.004）, no significant difference was found when comparing NS to 10 units, and 100 units HPS （10 units： OR=1.51, 95%CI 0.94 to 2.43, P=0.09; 100 units： OR=1.51, 95%CI 0.63 to 3.60, P=0.09）. Conclusion HPS appears to be more beneficial than NS, larger rigorously studies are needed for better understanding on the effects of NS and HPS.

关 键 词：生理盐水 肝素 中心静脉置管 冲管 系统评价 META分析 随机对照试验 

分 类 号：R472[医药卫生—护理学]