成人植入式静脉输液港相关感染危险因素的系统评价  

The risk factors of related infections on adult totally implantable venous access device(TIVAD): a systematic review

作　　者：吴超君[1] 缪晶[1] 张昕童 申秀红 朱金星[2] 刘扣英[1,2] 

机构地区：[1]南京医科大学护理学院,南京210000 [2]南京医科大学第一附属医院,南京210000

出　　处：《中国循证医学杂志》2018年第2期156-162,共7页Chinese Journal of Evidence-based Medicine

基　　金：江苏省重点学科建设项目(编号:苏教研[2012]2号);江苏省人民医院护理科研课题(编号:院发[2017]76号)

摘　　要：目的系统评价影响成人植入式静脉输液港相关感染的危险因素。方法计算机检索PubMed、EMbase、CINAHL、The Cochrane Library、CBM、WanFang Data、CNKI和VIP数据库,搜集有关成人植入式静脉输液港相关感染危险因素的病例-对照研究和队列研究,检索时限均为建库至2017年4月。由2名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RevMan 5.3软件进行Meta分析。结果共纳入1个病例-对照研究和12个队列研究,包括9 166例患者。Meta分析结果显示:每月导管使用时间长[RR=1.06,95%CI(1.02,1.10),P=0.001]、住院治疗[RR=2.53,95%CI(1.68,3.81),P<0.000 01]、姑息化疗[RR=2.71,95%CI(1.77,4.15),P<0.000 01]、肠外营养[RR=3.89,95%CI(2.37,6.40),P<0.000 01]、中性粒细胞减少[RR=2.20,95%CI(1.30,3.72),P=0.003]及血液系统恶性肿瘤[RR=3.54,95%CI(2.03,6.17),P<0.000 01]与成人植入式静脉输液港相关感染具有显著相关性。结论当前证据显示,成人植入式静脉输液港相关感染的危险因素包括导管每月使用时间长、住院治疗、姑息化疗、肠外营养、中性粒细胞减少和血液系统恶性肿瘤。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the risk factors of related infections on the totally implantable venous access device （TIVAD） in adult. Methods PubMed, EMbase, CINAHL, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect case-control studies and cohort studies about the risk factors of TIVAD-related infections in adult from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of one case-control study and 12 retrospective cohort studies involving 9 166 patients were included. The results of meta-analysis showed that： longer catheter utilization-days in the previous months （RR=I.06, 95%CI 1.02 to 1.10, P=0.001）, inpatient treatment （RR=2.53, 95%CI 1.68 to 3.81, P〈0.000 01）, palliative care （RR=2.71, 95%CI 1.77 to 4.15, P〈0.000 01）, parenteral nutrition （RR=3.89, 95%CI 2.37 to 6.40, P〈0.000 01）, neutropenia （RR=2.20, 95%CI 1.30 to 3.72, P=0.003） and haematological malignancies （RR=3.54, 95%CI 2.03 to 6.17, P〈0.000 01） were associated with increased risk of TIVAD-related infections in adult. Conclusion Current evidence shows that the risk factors of TIVAD-related infections include catheter utilization-days in the previous months, inpatient, palliative care, parenteral nutrition, neutropenia and hematological malignancies. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusion.

关 键 词：输液港 感染 成人 危险因素 META分析 系统评价 病例-对照研究 队列研究 

分 类 号：R472[医药卫生—护理学]