血液系统疾病患者置入中心静脉导管发生血栓相关危险因素的Meta分析

Meta analysis of risk factors for thrombosis in patients with hematological diseases receiving central venous catheter via peripheral vein puncture

目的分析血液系统疾病患者经外周静脉穿刺置入中心静脉导管相关血栓(PICC-RT)形成的独立风险因素。方法使用计算机系统对PubMed、Web of Science、Medline、中国知网、维普及万方等数据库进行主题词检索,搜集血液系统患者置入PICC导管相关血栓的病例对照研究。检索时间设置为建库至2022年6月,通过2名研究员分别独立对检索到的血液系统患者PICC-RT影响因素的文献进行筛选,评估文献质量并提取相关数据。对提取的数据采用Revman5.3软件进行Meta分析,以筛选出血液系统患者PICC-RT的危险因素。结果共纳入14篇文献,涉及3127例患者,分析了38项影响因素,根据是否发生PICC-RT将患者分为研究组(n=297)和对照组(n=2830)。根据Meta及统计分析结果,将OR≥1且P≤0.05的10项影响因素列为血液系统患者PICC-RT危险因素:年龄≥60岁、合并感染、危险度分层为中高危、BMI≥25、ECOG评分≥2分、既往手术史、PICC导管尖端位置异常、非隧道式PICC、血小板水平≥350×10^(9)/L、置管时间≥6个月。结论共发现10项血液系统患者PICC-RT的影响因素,可有助于血栓预防及疾病的风险分层。

Objective To evaluate independent risk factors for peripherally inserted central catheter-related thrombosis(PICC-RT).Methods Literature search of the PubMed,Web of Science,Medline,China National Knowledge Infrastructure,VIP Chinese Science and Technology Periodicals,and Wanfang databases was performed for case control studies investigating patients who experienced PICC-RT,published from database inception to June 2022.Subsequently,two investigators independently screened the retrieved studies for factors influencing PICC-RT according to pre-defined admission and discharge criteria,and evaluated study quality and extracted the relevant data.Review Manager version 5.3(The Cochrane Collaboration,2020)was used to perform Meta-analysis on the extracted data to determine risk factors for PICC-RT.Results A total of 14 literatures were included,involving 3127 patients,and 38 influencing factors were analyzed.Patients were divided into study group(n=297)and control group(n=2830)according to whether PICC-RT occurred.According to the results of Meta and statistical analysis,10 influencing factors with OR≥1 and P≤0.05 were listed as the risk factors for PICC-RT in patients with blood system:age≥60 years,coinfection,risk stratification as mediumhigh risk,BMI≥25,ECOG score≥2,previous surgical history,abnormal PICC catheter tip position,non-tunneling PICC,and platelet level≥350×10^(9)/L,and catheterization time>6 months.Conclusions A total of 10 factors influencing PICC-RT in hematological patients have been found,which may contribute to thrombosis prevention and disease risk stratification.