中国静脉留置针肝素钠封管与生理盐水封管效果比较的Meta分析

Effects of Venous Remaining Needle Sealing with Heparin vs. Saline in China:A Meta-Analysis

目的评价中国外周浅静脉留置针用生理盐水封管与用肝素钠封管的效果。方法采用Cochrane系统评价的方法,计算机检索中国学术期刊网全文数据库(1994～2009.12)和万方科技期刊全文数据库(1990～2009.12),查找比较生理盐水与肝素钠封管的RCT,对纳入RCT进行质量评价并提取有效数据,采用RevMan5.0软件进行Meta分析。结果共纳入9个RCT,合计1770例患者。Meta分析结果显示:①肝素钠封管在降低留置针堵管率方面优于生理盐水封管,其差异有统计学意义[OR=0.44,95%CI(0.32,0.62),P<0.05]。②在静脉炎发生率方面,两者差异无统计学意义[OR=1.26,95%CI(0.64,2.50),P>0.05]。③在平均留置时间上,两者差异有统计学意义[WMD=0.24,95%CI(0.04,0.43),P<0.05],肝素钠封管优于生理盐水封管。结论本系统评价结果显示,肝素钠封管在降低静脉留置针的堵管率和延长留置时间方面优于生理盐水,但是在预防静脉炎的发生方面两者无明显差异。

Objective To evaluate the effects of peripheral venous remaining needle sealing with heparin vs.saline in China.Methods A comprehensive,systematic bibliographic search of medical literature from databases of CNKI（1994 to December,2009） and Wanfang（1990 to December,2009） was conducted to identify randomized controlled trials（RCTs） related to catheter sealing with saline vs.heparin.The remaining time of venous needle,the incidence of phlebitis and the catheter blockage were compared,and the quality of RCTs was assessed and meta-analyses were conducted by RevMan 5.0 software.Results Nine RCTs involving 1 770 patients were included.The results of meta-analyses showed that：a） There was a significant difference between heparin sealing and saline sealing in catheter blockage（OR=0.44,95%CI 0.32 to 0.62,P0.05）.The heparin sealing was much better to prevent catheter blockage;b） There was no significant difference between saline sealing and heparin sealing in the incidence of phlebitis（OR=1.26,95%CI 0.64 to 2.50,P0.05）;and c） The average remaining time of venous catheter between saline sealing and heparin sealing had significant difference（WMD=0.24,95%CI 0.04 to 0.43,P0.05）.Heparin sealing had better effect than saline sealing.Conclusion The meta-analyses of current medical literature in China show that heparin sealing can reduce the incidence of catheter blockage and prolong the remaining time of catheter,although there is no significant effect in the aspect of the incidence of phlebitis.