中等长度导管及经外周静脉穿刺中心静脉置管导管相关血流感染发生率的Meta分析  

Incidence of catheter-related bloodstream infection in patients with midline catheters and peripherally inserted central catheters:a Meta-analysis

作　　者：鲁华鹏 马梅 何晴 郎澜 田波彦 肖奇贵 杨勤玲[1] 吕毅[1] 辛霞[4] 郑雪梅[4] LU Hua-peng;MA Mei;HE Qing;LANG Lan;TIAN Bo-yan;XIAO Qi-gui;YANG Qin-ling;LYU Yi;XIN Xia;ZHENG Xue-mei(Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China;School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China;School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China;Department of Nursing, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061 [2]西安交通大学医学部公共卫生学院,陕西西安710061 [3]西安交通大学医学部护理学院,陕西西安710061 [4]西安交通大学第一附属医院护理部,陕西西安710061

出　　处：《中国感染控制杂志》2021年第4期309-319,共11页Chinese Journal of Infection Control

基　　金：西安交通大学第一附属医院基金(2019HL-09)。

摘　　要：目的通过Meta分析探究中等长度导管(MC)与经外周静脉穿刺中心静脉置管(PICC)静脉输液治疗导管相关血流感染(CRBSI)发生率,以期为临床静脉输液治疗过程防治CRBSI提供参考。方法检索Web of Science、PubMed、Scopus、Embase、Cochrane Library、ProQuest、CNKI、万方、维普、CBM数据库,收集MC与PICC发生的CRBSI相关研究,检索时间均为建库至2020年1月。由两名研究者按照纳入与排除标准独立检索、筛选文献、质量评价与提取资料,应用RevMan 5.3软件进行分析。结果最终纳入文献15篇,共计34235例患者,MC组CRBSI发生率为0.58%(43/7392),PICC组CRBSI发生率为0.53%(142/26843),Meta分析显示MC组CRBSI发生率低于PICC组(RR=0.63,95%CI=0.43~0.93,P=0.02)。除其他国家亚组MC组CRBSI发生率与PICC组差异无统计学意义(P>0.05)外,中国亚组MC组CRBSI发生率低于PICC组(RR=0.21,95%CI=0.07~0.64),美国亚组MC组CRBSI发生率低于PICC组(RR=0.53,95%CI=0.31~0.89),英国亚组MC组CRBSI发生率高于PICC组(RR=3.67,95%CI=1.18~11.37),差异均有统计学意义(均P<0.05)。成人亚组、其他亚组MC组CRBSI发生率与PICC组比较,差异均无统计学意义(均P>0.05)。随机对照研究亚组MC组CRBSI发生率低于PICC组[(RR=0.12,95%CI=0.02~0.66),P=0.01],回顾性队列研究亚组MC组CRBSI发生率与PICC组比较,差异无统计学意义(P>0.05)。总体各研究间稳定性一般,质量良好和中等研究间稳定性好,无明显发表偏倚。结论首次对MC与PICC发生CRBSI风险进行系统评价与Meta分析,静脉输液治疗过程中MC组CRBSI发生率低于PICC组,在同等条件下可考虑优先选择MC为患者进行静脉输液治疗。仍需更多高质量及儿童相关研究进一步评估、探究MC与PICC发生CRBSI的风险。Objective To explore the incidence of catheter-related bloodstream infection(CRBSI)in the process of intravenous infusion therapy through midline catheters(MC)and peripherally inserted central catheters(PICC)by Meta-analysis,so as to provide reference for clinical prevention and treatment of CRBSI in the process of intravenous infusion therapy.Methods Web of Science,PubMed,Scopus,Embase,Cochrane Library,ProQuest,China National Knowledge Infrastructure(CNKI),Wanfang,VIP and China Biology Medicine(CBM)were searched to collect the related studies of CRBSI in the process of intravenous infusion therapy through MC and PICC,the retrieval time was from the establishment of the database to January 2020.According to the inclusion and exclusion criteria,two researchers independently searched and screened literatures as well as evaluated and extracted data,Revman 5.3 software was used for analysis.Results A total of 15 studies were collected,involving 34235 patients,incidence of CRBSI in MC and PICC groups were 0.58%(43/7392)and 0.53%(142/26843)respectively.Meta-analysis showed that incidence of CRBSI in MC group was lower than that in PICC group(RR=0.63,95%CI=0.43-0.93,P=0.02).Except that there was no significant difference in incidence of CRBSI between MC group and PICC group in other country subgroups(P>0.05),incidence of CRBSI in MC group was lower than that of PICC group in Chinese subgroup(RR=0.21,95%CI=0.07-0.64)and American subgroup(R=0.53,95%CI=0.31-0.89),but in British subgroup was higher than PICC group(RR=3.67,95%CI=1.18-11.37),diffe-rences were all significant(all P<0.05).There were no significant differences in the incidence of CRBSI between MC group and PICC group in adult subgroup and other subgroups(all P>0.05).Incidence of CRBSI in MC group was lower than PICC group in randomized controlled study subgroup(RR=0.12,95%CI=0.02-0.66,P=0.01),but incidence of CRBSI in MC group and PICC group was not significantly different in retrospective cohort study subgroup(P>0.05).The overall stability of each study was com

关 键 词：中等长度导管 经外周静脉穿刺中心静脉置管 静脉输液治疗 导管相关血流感染 META分析 

分 类 号：R181.32[医药卫生—流行病学]