PICC置管后首次换药时间的系统综述和Meta分析  

Systematic review and Meta-analysis of first dressing change time after PICC placement

作　　者：张雨虹 邱艳茹[1] 万永慧[1] ZHANG Yuhong;QIU Yanru;WAN Yonghui(Cancer center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肿瘤中心,湖北武汉430060

出　　处：《现代医学》2024年第4期618-627,共10页Modern Medical Journal

摘　　要：目的:系统评价经外周静脉置入中心导管(PICC)后首次换药时间对穿刺点渗血和导管相关感染的影响,为临床实践提供参考依据。方法:计算机检索PubMed、Web of Science、Embase、Cochrane library、中国知网、万方数据库、维普期刊数据库、中国生物医学文献数据库,搜集关于PICC置管后首次换药的随机对照研究文献和队列研究文献,检索时限为自建库起至2023年6月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果:最终纳入8篇文献、1 874例患者,PICC置管后首次换药时间延长至48 h或72 h与传统24 h首次换药相比,穿刺点渗血发生率降低(RR=0.63,95%CI 0.50~0.80,P=0.000 1),而导管相关感染发生率差异无统计学意义(RR=1.36,95%CI 0.73~2.53,P=0.33);首次换药时间延长至48 h与延长至72 h相比,PICC置管后穿刺点渗血(P=0.63)和导管相关感染(P=0.64)发生率差异均无统计学意义。结论:PICC置管后首次换药时间可适当延长至48 h或72 h。Objective:To systematically evaluate the effects of the first dressing change time after peripherally inserted central catheter(PICC)placement on bleeding at the puncture site and catheter related infection,and to provide evidence for clinical practice.Methods:PubMed,Web of Science,Embase,Cochrane library,CNKI,Wanfang Database,VIP Journal database and China Biomedical Literature Database were searched for randomized controlled trials and cohort trials about the first dressing change after PICC catheterization.The search time limit was from the establishment of the database to June 2023.Two researchers independently screened the literature,extracted data and assessed the risk of bias of the included studies.RevMan 5.4 software was used for Meta-analysis.Results:Eight studies involving 1874 patients were included.After the first dressing change time was extended to 48 h or 72 h after PICC placement,the incidence of bleeding at the puncture site was reduced compared with the first dressing change at 24 h(RR=0.63,95%CI 0.50-0.80,P=0.0001),and there was no significant difference in the incidence of catheter related infection between the two groups(RR=1.36,95%CI 0.73-2.53,P=0.33).When the first dressing change time was extended to 48 h compared with 72 h,there was no significant difference in the incidence of bleeding(P=0.63)and catheter-related infection(P=0.64)after PICC placement.Conclusion:The first dressing change time after PICC catheterization can be appropriately extended to 48 or 72 h.

关 键 词：经外周静脉置入中心导管 换药 渗血 感染 META分析 

分 类 号：R472[医药卫生—护理学]