经周围静脉穿刺置入中心静脉导管的白血病患者发生导管相关感染危险因素的Meta分析  

Risk factors for peripherally inserted central venous catheters related infection in leukemia patients: a Meta-analysis

作　　者：蒋鸣燕 王佳玲 杨凡 高举 朱易萍 李晋蓉 Jiang Mingyan;Wang Jialing;Yang Fan;Gao Ju;Zhu Yiping;Li Jinrong(Department of Pediatrics,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院儿科四川大学出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《国际输血及血液学杂志》2021年第3期221-231,共11页International Journal of Blood Transfusion and Hematology

基　　金：四川省科技厅重点研发项目(2020YFS0253);四川省卫健委项目(150106)。

摘　　要：目的系统性评价经周围静脉穿刺置入中心静脉导管(PICC)的白血病患者发生导管相关感染的危险因素。方法计算机检索PubMed、Ovid-Medline、Embase、Web of Science和Scopus等英文数据库,以及中国期刊全文数据库(CNKI),万方数据知识服务平台、中文科技期刊数据库(CSTJ)等中文数据库,搜集白血病患者发生PICC导管相关感染的病例对照研究(CCS)文献。文献检索时间为2005年1月1日至2020年8月15日。由2位研究者根据本研究设定的文献纳入和排除标准,对白血病患者发生PICC导管相关感染影响因素的文献进行独立筛选,评价文献质量并提取资料。采用Revman 5.3软件对白血病患者发生PICC导管相关感染的影响因素进行Meta分析。结果本研究纳入13篇CCS文献,共计纳入2147例患者,根据是否发生PICC导管相关感染将其分为研究组(n=360)和对照组(n=1787)。本研究Meta分析结果表明,白血病患者发生PICC导管相关感染的危险因素为年龄≥60岁(OR=2.35,95%CI:1.75~3.14,P<0.001),年龄≥65岁(OR=24.81,95%CI:5.21~118.14,P<0.001),合并糖尿病(OR=5.92,95%CI:3.60~9.74,P<0.001),合并其他基础疾病(OR=2.79,95%CI:2.06~3.78,P<0.001),接受糖皮质激素治疗(OR=4.99,95%CI:2.15~11.59,P<0.001),免疫功能低下(OR=6.61,95%CI:2.02~21.66,P=0.002),化疗次数≥6次(OR=3.10,95%CI:2.22~4.33,P<0.001),PICC穿刺次数>2次(OR=3.31,95%CI:2.23~4.92,P<0.001),PICC置管季节为夏季(OR=6.44,95%CI:3.67~11.31,P<0.001),PICC置管时长≥2个月(OR=3.42,95%CI:2.11~5.55,P<0.001),导管脱出(OR=2.46,95%CI:1.47~4.11,P<0.001),PICC置管期间换药时间间隔>8 d(OR=3.05,95%CI:2.14~4.35,P<0.001),医护人员PICC置管经验<50例(OR=2.95,95%CI:1.89~4.59,P<0.001)。结论白血病患者PICC导管相关感染的危险因素较多,因此在PICC置管前、后,应尽量避免可控制的危险因素,如控制糖尿病和其他基础疾病、提高患者免疫功能、减少穿刺次数、固定导管防止脱出、及时换药,以及增加�Objective To systematically evaluate risk factors for peripherally inserted central venous catheters(PICC)related infection in leukemia patients.Methods PubMed,Ovid-Medline,Embase,Web of Science,Scopus,China National Knowledge Infrastructure(CNKI),Wanfang Database and China Science and Technology Journal Database(CSTJ)were searched by computer,to collect case-control study(CCS)about PICC related infection in leukemia patients from January 1,2005 to August 15,2020.According to the literature inclusion and exclusion criteria set by this study,two researchers independently screened the literature on risk factors of PICC related infection in leukemia patients,then evaluated the quality of the literature and extracted data.Meta-analysis of risk factors for PICC related infections in leukemia patients were performed with Revman 5.3 software.Results A total of 13 CCS were included in this Meta-analysis.A total of 2147 leukemia patients were included.And according to whether occurred PICC related infection,they were divided into study group(n=360)and control group(n=1787).The results of this Meta-analysis showed that the risk factors of PICC related infection in leukemia patients were as follows:age≥60 years(OR=2.35,95%CI:1.75-3.14,P<0.001),age≥65 years(OR=24.81,95%CI:5.21-118.14,P<0.001),combination with diabetes(OR=5.92,95%CI:3.60-9.74,P<0.001),combination with other basic diseases(OR=2.79,95%CI:2.06-3.78,P<0.001),receiving glucocorticoid therapy(OR=4.99,95%CI:2.15-11.59,P<0.001),abnormal immunity(OR=6.61,95%CI:2.02-21.66,P=0.002),chemotherapy course≥6 courses(OR=3.10,95%CI:2.22-4.33,P<0.001),number of PICC puncture>twice(OR=3.31,95%CI:2.23-4.92,P<0.001),PICC puncture in summer(OR=6.44,95%CI:3.67-11.31,P<0.001),PICC duration≥2 months(OR=3.42,95%CI:2.11-5.55,P<0.001),catheter extrusion(OR=2.46,95%CI:1.47-4.11,P<0.001),dressing interval during PICC>8 d(OR=3.05,95%CI:2.14-4.35,P<0.001),experience of medical staff in catheterization<50 cases(OR=2.95,95%CI:1.89-4.59,P<0.001).Conclusions There are many risk factors f

关 键 词：白血病 导管插入术 外周 感染 危险因素 META分析 

分 类 号：R473.73[医药卫生—护理学]