血液透析中心静脉导管相关性血流感染危险因素的Meta分析  

Risk factors for central venous catheter-related blood stream infection in hemodialysis center:a Meta-analysis

作　　者：李兰 温贤秀[2] 夏琪[2] 肖力 曹海霞 谢林娟 LI Lan;WEN Xianxiu;XIA Qi;XIAO Li;CAO Haixia;XIE Linjuan(School of Nursing,Chengdu University of TCM,Sichuan 611137 China)

机构地区：[1]成都中医药大学护理学院,四川611137 [2]四川省人民医院

出　　处：《循证护理》2021年第16期2164-2169,共6页Chinese Evidence-Based Nursing

摘　　要：目的:系统评价血液透析中心静脉导管相关性血流感染的危险因素。方法:计算机检索PubMed、Web of Science、EMbase、中国知网(CNKI)、万方(WanFang Data)、中国生物医学文献数据库(CBM)、维普(VIP)中有关血液透析中心静脉导管相关血流感染危险因素的研究,检索时间为建库至2020年9月1日。使用RevMan 5.3软件进行Meta分析。结果:共纳入24篇文献,Meta分析结果显示,年龄≥60岁[OR=2.52,95%CI(1.82,3.49),P<0.01]、股静脉置管[OR=1.39,95%CI(1.03,1.89),P=0.03]、导管留置时间≥7 d[OR=0.22,95%CI(0.15,0.32),P<0.01]、穿刺次数≥2次[OR=0.33,95%CI(0.17,0.62),P<0.01]、糖尿病[OR=2.29,95%CI(1.94,2.72),P<0.01]、低蛋白血症[OR=3.09,95%CI(1,79,5.33),P<0.01]、贫血[OR=3.74,95%CI(2.37,5.90),P<0.01]、住院时间≥2周[OR=0.30,95%CI(0.16,0.55),P<0.01]、白细胞计数[WMD=3.74,95%CI(2.10,5.37),P<0.01]、红细胞计数[WMD=-0.92,95%CI(-1.06,0.78),P<0.01]、血尿素氮[WMD=3.86,95%CI(2.73,5.00),P<0.01]、体质指数[WMD=-1.60,95%CI(-2.45,-0.76),P<0.01]是血液透析中心静脉导管相关性血流感染的危险因素。结论:现有证据表明,年龄≥60岁、股静脉置管、导管留置时间≥7 d、穿刺次数≥2次、糖尿病、低蛋白血症、贫血、住院时间≥2周、白细胞计数、红细胞计数、血尿素氮、体质指数是血液透析中心静脉导管相关血流感染的危险因素,医护人员应及时识别并处理相关危险因素,预防血液透析中心静脉导管相关血流感染的发生。因纳入研究整体质量一般,尚需设计严谨、大样本的前瞻性队列研究对本结果进行进一步验证。Objective:To systematically evaluate the risk factors of central venous catheter-related bloodstream infection in hemodialysis center.Methods:Literatures on risk factors for catheter-related bloodstream infection in hemodialysis patients were retrieved from PubMed,Web of Science,EMbase,CNKI,WanFang Data,CBM and VIP,the retrieval time was from the establishment of database to September 1,2020,RevMan 5.3 software was used for Meta-analysis.Results:A total of 24 literatures were included.Meta-analysis result showed that age≥60 years old[OR=2.52,95%CI(1.82,3.49),P<0.01],femoral vein catheterization[OR=1.39,95%CI(1.03,1.89),P=0.03],catheter indwelling time≥7 d[OR=0.22,95%CI(0.15,0.32),P<0.01],number of puncture≥2[OR=0.33,95%CI(0.17,0.62),P<0.01],diabetes mellitus[OR=2.29,95%CI(1.94,2.72),P<0.01],hypoproteinemia[OR=3.09,95%CI(1,79,5.33),P<0.01],anemia[OR=3.74,95%CI(2.37,5.90),P<0.01],hospital stay≥2 weeks[OR=0.30,95%CI(0.16,0.55),P<0.01],WBC[WMD=3.74,95%CI(2.10,5.37),P<0.01],RBC[WMD=-0.92,95%CI(-1.06,0.78),P<0.01],BUN[WMD=3.86,95%CI(2.73,5.00),P<0.01],BMI[WMD=-1.60,95%CI(-2.45,-0.76),P<0.01]were the risk factors of central venous catheter-related bloodstream infection in hemodialysis center.Conclusion:Current evidences shows that age≥60 years old,femoral vein catheterization,catheter indwelling time,number of puncture≥2,diabetes mellitus,WBC,RBC,and BMI were the risk factors of central venous catheter-related bloodstream infection in hemodialysis center,Medical staff should timely identify and deal with relevant risk factors to prevent the occurrence of venous catheter-related blood flow infection in hemodialysis center.Due to the general quality of the included studies,a prospective cohort study with rigorous design and large samples is needed to further verify the results.

关 键 词：血液透析 中心静脉导管相关性血流感染 危险因素 META分析 循证护理 

分 类 号：R473.5[医药卫生—护理学]