经隧道式中心静脉导管行血液透析导管相关血流感染发病率及危险因素的系统评价与Meta分析  

Incidence and risk factors for catheter-related bloodstream infections in hemodialysis through tunneled central venous catheters:a systematic review and meta-analysis

作　　者：豆欣蔓[1,2] 谢琪 张丽红 钟娟平[3] 王兴蕾 DOU Xin-man;XIE Qi;ZHANG Lihong;ZHONG Juan-ping;WANG Xing-lei(Department of Nursing,Lanzhou University Second Hospital,Lanzhou 730000,China;School of Nursing,Lanzhou University,Lanzhou 730000,China;Department of Neurology,Lanzhou University Second Hospital,Lanzhou 730000,China;Department of Liver Diseases Branch,Lanzhou University Second Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院护理部,兰州730000 [2]兰州大学护理学院,兰州730000 [3]兰州大学第二医院神经内科,兰州730000 [4]兰州大学第二医院肝病科,兰州730000

出　　处：《中国血液净化》2023年第3期215-221,共7页Chinese Journal of Blood Purification

基　　金：甘肃省哲学社会科学规划项目阶段性研究成果(2022YB154);2020年甘肃省省级科技计划(重点研发计划)(20YF8FA077)。

摘　　要：目的系统评价经隧道式中心静脉导管行血液透析导管相关血流感染(catheter-related blood stream infection,CRBSI)发病率及危险因素。方法检索从建库到2022年9月PubMed、Web of science、Embase、Cochrane Library、中国知网、维普、万方和中国生物医学文献数据库,搜集报道了CRBSI发病率和/或危险因素的临床研究。采用R语言(version 4.1.2)进行单组率和危险因素的Meta分析。结果共纳入21篇文献,6758例经隧道式中心静脉导管行血液透析的患者。Meta分析结果显示:CRBSI总发病率为14.5%,欧洲人群发病率为28.9%(95%CI:16.2%~43.5%),病例对照研究的发病率为26.3%(95%CI:14.1%~40.7%),年龄≥60岁人群发病率为22.2%(95%CI:14.5%~31.0%),导管使用时间>24个月的发病率为28.2%(95%CI:2.5%~67.2%)。年龄≥60岁(OR=1.85,95%CI:1.29~2.64)、白蛋白<30g/L(OR=2.12,95%CI:1.40~3.22)、股静脉置管(OR=2.17,95%CI:1.24~3.80)、合并糖尿病(OR=1.82,95%CI:1.37~2.40)、置管时间≥4周(OR=2.04,95%CI:1.22~3.41)是经隧道式中心静脉导管行血液透析患者发生CRBSI的重要危险因素。结论经隧道式中心静脉导管行血液透析CRBSI发生率较高,年龄≥60岁、白蛋白<30g/L、股静脉置管、合并糖尿病、置管时间≥4周是CRBSI的重要危险因素。Objective To systematically review the incidence and risk factors for catheter-related bloodstream infection(CRBSI)in hemodialysis patients undergoing tunneled central venous catheterization.Methods PubMed,Web of science,Embase,Cochrane Library,CBM,WanFang Data,VIP and CNKI databases from the establishment of the database to September 2022 were searched for clinical studies about the incidence and/or risk factors of CRBSI.R software(version 4.1.2)was used for meta-analysis of single-group rate and risk factors.Results A total of 21 studies were included,including 6,758 patients undergoing hemodialysis through tunneled central venous catheters.Meta-analysis showed that the pooled incidence of CRBSI was 14.5%,the incidence was 28.9%in European population(95%CI:16.2%~43.5%),and the incidence was 26.3%from case-control study(95%CI:14.1%~40.7%).The incidence was 22.2%(95%CI:14.5%,31.0%)in patients aged≥60 years,and 28.2%(95%CI:2.5%~67.2%)in patients with catheterization duration of>24 months.Age≥60 years old(OR=1.85,95%CI:1.29~2.64),albumin<30g/L(OR=2.12,95%CI:1.40~3.22),femoral vein catheterization(OR=2.17,95%CI:1.24~3.80),diabetes mellitus(OR=1.82,95%CI:1.37~2.40),and catheterization period≥4 weeks(OR=2.04,95%CI:1.22~3.41)were the important risk factors for CRBSI in hemodialysis patients undergoing tunneled central venous catheterization.Conclusion The incidence of CRBSI is higher in patients undergoing hemodialysis through tunneled central venous catheter.Age≥60 years,albumin<30g/L,femoral vein catheterization,diabetes mellitus,catheterization period≥4 weeks are the important risk factors for CRBSI.

关 键 词：血液透析 隧道式中心静脉导管 导管相关血流感染 发病率 危险因素 

分 类 号：R459.5[医药卫生—治疗学]