皮肤消毒剂预防重症患者血管导管相关感染的网状Meta分析  

Prevention of skin antiseptic solutions for intravascular catheter-related infection in intensive care unit:a network Meta-analysis

作　　者：曹立娟 杨涛[1] 刘素霞[1] 邹秀珍[1] 陈亚男[1] 刘菁[1] CAO Li-juan;YANG Tao;LIU Su-xia;ZOU Xiu-zhen;CHEN Ya-nan;LIU Jing(The First People's Hospital of Lianyungang,Lianyungang 222006,China)

机构地区：[1]连云港市第一人民医院,江苏连云港222006

出　　处：《中国消毒学杂志》2024年第8期594-598,共5页Chinese Journal of Disinfection

基　　金：江苏省医院协会医院管理专项基金资助项目(JSYGY-1-2021-JZ39)。

摘　　要：目的评价皮肤消毒剂预防重症患者血管导管相关感染的有效性。方法计算机检索PubMed、Cochrane Library、中国知网(CNKI)和万方数据库,搜集重症患者置入血管导管前皮肤消毒的随机对照试验(RCT),检索时限均从建库至2021年10月8日,采用Stata 17和R 4.2软件进行网状Meta分析。结果共纳入8个RCT,共计4990例患者和8749例导管,涉及8种皮肤消毒剂,分别为0.5%、1%和2%氯己定醇、2%氯己定水溶液、氯己定混合溶液(0.25%氯己定+0.025%苯扎氯铵+4%苯甲醇,CBB)、10%聚维酮碘、5%聚维酮碘醇和70%异丙醇。网状Meta分析结果显示,2%氯己定醇的导管病原菌定植发生率低于5%聚维酮碘醇[OR=0.18,95%CI(0.04~0.89)],概率排序结果为2%氯己定醇>CBB>2%氯己定水溶液>1%氯己定醇>5%聚维酮碘醇>0.5%氯己定醇>70%异丙醇>10%聚维酮碘。在降低导管相关血流感染方面,8种皮肤消毒剂之间差异均无统计学意义(P>0.05),概率排序结果为2%氯己定醇>CBB>1%氯己定醇>2%氯己定水溶液>0.5%氯己定醇>70%异丙醇>5%聚维酮碘醇>10%聚维酮碘。结论2%氯己定醇在预防重症患者血管导管相关感染效果更优。Objective To systematically review the effect of skin antiseptic solutions for the prevention of intravascular catheter-related infection in critically ill patients.Methods PubMed,Cochrane Library,CNKI and Wanfang Data were searched to collect randomized controlled trials(RCTs)of skin disinfectantsin intensive care units with vascular catheter from inception to October 8th,2022.Statistical analysis was performed by Stata 17 and R 4.2 software.Results A total of 8 RCTs involving 4990 patients and 8749 catheters with eight antiseptic agents including 0.5%,1%and 2%CHG-alcohol,2%CHG-aqueous,CHG mixedsolution(0.25%chlorhexidine gluconate,0.025%benzalkonium chloride,and 4%benzylic alcohol,CBB),10%povidone-iodine(PVI),5%PVI-alcohol and 70%isopropyl alcohol were included.The network Meta-analysis showed that 2%CHG-alcohol had a significant reduction in the incidence of catheter colonization compared with 5%PVI-alcohol(OR=0.18,95%CI 0.04-0.89).The probabily rank were 2%CHG-alcohol>CBB>2%CHG-aqueous>1%CHG-alcohol>5%PVI-alcohol>0.5%CHG-alcohol>70%isopropyl alcohol>10%PVI.In reducing the catheter-related bloodstream infections,there was no statistically significant difference among the eight skin disinfectants,and the probabily rank were 2%CHG-alcohol>CBB>1%CHG-alcohol>2%CHG-aqueous>0.5%CHG-alcohol>70%isopropyl alcohol>5%PVI-alcohol>10%PVI.Conclusions 2%CHG-alcohol is a priority choice for the prevention and control of intravascular catheter-related infection in critically ill patients.

关 键 词：皮肤消毒剂 重症 血管导管相关感染 网状Meta分析 

分 类 号：R187[医药卫生—流行病学]