不同腹膜透析置管相关技术对患者预后影响的Meta分析  

Effects of different peritoneal dialysis catheterization techniques on the prognosis of patients:a metaanalysis

作　　者：杜渊 蒋宏伟 李春庆 谢燕[2] Du Yuan;Jiang Hongwei;Li Chunqing;Xie Yan(Department of Nephrology,Affiliated Hospital of Jiangnan University,Wuxi 214041,Jiangsu Province,China;Department of Geriatrics,First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]江南大学附属医院肾内科,江苏省无锡市214041 [2]苏州大学第一附属医院老年科,江苏省苏州市215006

出　　处：《中国组织工程研究》2021年第28期4567-4572,共6页Chinese Journal of Tissue Engineering Research

摘　　要：目的:对于腹膜透析患者来说,哪种腹透置管技术更具有临床优势一直存在争议,目前尚缺乏高等级循证医学证据。文章通过比较不同腹透管置管技术对腹膜透析患者预后的影响进行系统评价,探讨经皮穿刺置管技术的临床价值。方法:计算机检索PubMed、EMbase、the Cochrane Library、中国知网、维普和万方数据库,收集国内外公开发表的关于经皮穿刺技术和腹膜切开技术进行腹膜透析置管比较的队列研究文献,检索时限均为建库至2019-10-30,选取有效数据,用纽卡斯尔-渥太华量表(NOS)进行质量评估,以感染并发症、机械并发症、1年腹透管生存率和并发症导致的拔管率为主要观察指标,以比值比(OR)为效应指标,用RevMan 5.3软件对数据进行Meta分析。结果:①共纳入12个研究,前瞻性队列研究2个,回顾性队列研究10个,共2203例患者,经皮穿刺组(经皮组)1164例,腹膜切开组(手术组)1039例;②感染并发症率、机械并发症率和腹透管1年生存率方面,经皮组和手术组比较,组间差异均无显著性意义(OR=0.57,95%CI:0.31-1.04,P=0.07;OR=0.88,95%CI:0.77-1.09,P=0.25;OR=1.05,95%CI:0.68-1.64,P=0.81);③并发症致拔管率方面,经皮组要低于手术组(OR=0.59,95%CI:0.47-0.74,P<0.0001);④对感染并发症组和腹透管1年生存率组按研究类型进行亚组分析结果提示,异质性来自于回顾性研究亚组,亚组间的Meta分析结果显示两组无显著性差异;⑤漏斗图分析结果提示,纳入文献的腹透管感染并发症和1年生存率指标有轻度的发表偏倚。结论:用经皮穿刺技术进行腹膜透析置管安全有效,总体疗效和预后与腹膜切开技术类似,可成为后者较为理想的替代方式。OBJECTIVE:For peritoneal dialysis patients,the more therapeutic way of insertion catheterization techniques is controversial.There is no evidence of highgrade evidence-based medicine.This study systemically assessed influence of different insertion catheterization techniques on the prognosis of peritoneal dialysis patients,and reviewed the clinical value of percutaneous insertion catheterization in peritoneal dialysis.METHODS:The PubMed,EMbase,the Cochrane Library,CNKI,VIP,and Wanfang databases of cohort study literature on the comparison of percutaneous technique and surgical incision technique for peritoneal dialysis catheterization published from inception to October 30,2019 were searched by computer.The effective data were selected and the Newcastle-Ottawa Scale was used to evaluate the quality.Primary outcomes were infection complications,mechanical complications,1-year peritoneal dialysis tube survival rate,and extubation rate caused by complications.The odds ratio(OR)was the effect indicator.Metaanalysis was performed using RevMan 5.3 software.RESULTS:(1)A total of 12 studies were included,including 2 prospective cohort studies and 10 retrospective cohort studies.A total of 2203 patients were enrolled,including 1164 patients in the percutaneous puncture group and 1039 patients in the peritoneal incision group.(2)The incidence of infection complications,the incidence of mechanical complications,and the 1-year catheter survival rate were not statistically significant between the percutaneous puncture group and the peritoneal incision group(OR=0.57,95%CI:0.31-1.04,P=0.07:OR=0.88,95%CI:0.77-1.09,P=0.25;OR=1.05,95%CI:0.68-1.64,P=0.81).(3)The extubation rate caused by complications in the percutaneous puncture group was lower than in the peritoneal incision group(OR=0.59,95%CI:0.47-0.74,P<0.0001).(4)Subgroup analysis results of cases of infection complications group and 1-year catheter survival rate group according to the type of study suggested that heterogeneity mainly came from retrospective study subgroups,a

关 键 词：腹膜透析导管 肾衰竭 肾透析 经皮穿刺 透视引导 腹膜切开 手术切开 META分析 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]