经外周静脉穿刺中心静脉置管治疗肿瘤患者血栓发生率的Meta分析  

The Risk of Thrombosis with Peripherally Inserted Central Catheters in Cancer Patients:a Meta-analysis

作　　者：王朋朋[1] 应燕萍[1] 黄惠桥[1] 凌瑛[1] 赵慧函 朱薇[1] 

机构地区：[1]广西医科大学第一附属医院,广西南宁市530021

出　　处：《中国全科医学》2017年第26期3259-3266,共8页Chinese General Practice

基　　金：广西医疗卫生适宜技术研究与开发项目(S201524)

摘　　要：目的通过Meta分析的方法探讨肿瘤患者应用植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)血栓发生风险的情况。方法计算机检索中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、Cochrane Library、PubMed、EMBase数据库中关于VAP(对照组)与PICC(PICC组)治疗肿瘤患者血栓发生率的随机对照试验、队列研究。检索时间从建库至2016年7月。进行资料提取及质量评价,采用Stata 12.0软件对数据进行Meta分析。结果共纳入4项随机对照试验、17项队列研究,共4 095例患者。Meta分析结果显示,PICC组血栓发生率高于对照组[RR=2.88,95%CI(1.92,4.33)]。根据PICC人员分为医生置管、护士参与置管、未报道3个亚组,Meta分析结果显示,当护士参与置管时,PICC组与对照组肿瘤患者血栓发生率比较,差异无统计学意义[RR=1.90,95%CI(0.93,3.89)]。医生置管、未报道两亚组,PICC组血栓发生率高于对照组[RR=3.06,95%CI(1.13,8.26);RR=3.83,95%CI(2.14,6.88)]。其他亚组分析显示,患者类型为住院患者、住院和出院患者,患者平均年龄≥18岁、<18岁,PICC方式为未报道、盲穿或超声引导、超声引导,是否报道血栓诊断方法,研究类型为队列研究,不同发表国家PICC组血栓发生率均高于对照组。Begg秩相关法和Egger's直线回归法提示研究间无发表偏倚。结论与PICC比较,肿瘤患者采用VAP可以降低血栓的发生风险;由护士参与置管可以降低PICC血栓发生率;但是在临床应用中,肿瘤患者是否选择PICC还需要综合考虑其利弊。Objective Through the method of meta analysis to compare the risk of thrombosis between vascular access port（ VAP） and peripherally inserted central catheter（ PICC） in cancer patients. Methods We searched Chinese Biomedical Literature database（ CBM）,CNKI,Wanfang database,VIP,Cochrane Library, PubMed, EMBase by computer to collect clinical randomized controlled trials and cohort studies on the risk of thrombosis between VAP（ control group） and PICC（ PICC group） in cancer patients. The search time was from the database building to July 2016. The data were extracted,and quality were evaluated. Stata 12. 0 software was used for meta analysis of the data. Results A total of 4 095 patients in the 4 randomized controlled trials and 17 cohort studies were included in the study. The results of meta analysis showed that the incidence of thrombosis in PICC group was higher than that in control group [RR = 2. 88,95% CI（ 1. 92,4. 33） ]. According to the PICC staff,the studies were divided into 3 subgroups： doctor-inserting subgroup,nurse-involving subgroup and not reported subgroup. The results of meta analysis showed that there was no significant difference in the incidence of thrombosis between the PICC group and the control group when the nurses participated in inserting catheters [RR = 1. 90,95% CI（ 0. 93,3. 89） ]. The incidence of thrombosis in PICC group was higher than that in control group in the doctor-inserting subgroup and not reported subgroup [RR = 3. 06,95% CI（ 1. 13,8. 26）; RR = 3. 83,95% CI（ 2. 14,6. 88） ]. The results of other subgroups analysis showed that the incidence of thrombosis in PICC group was higher than that in control group among hospitalized patients and hospitalized and discharged patients,among the patients＇ average age more than 18 years old and 18 years old,among PICC method not reported, blind or ultrasound guided and ultrasound guided, among the subgroups whether the thrombosis diagnosis method was reported,cohort studies,and different published count

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

分 类 号：R364.15[医药卫生—病理学]