静脉留置针两种更换方式的系统评价

Systematic Review for Two Types of Replacement Strategy of Peripheral Venous Catheter

目的系统评价静脉留置针定期更换与根据置入部位的临床症状按需更换两种更换方式下并发症的发生率,以寻求静脉留置针的最佳更换方式。方法遵循循证医学的原则,运用Cochrane系统评价的方法,全面收集关于静脉留置针留置时间的临床随机对照试验,由2名评价者对文献进行质量评定和数据提取。用Cochrane协作网提供的RevMan 5.0.18统计软件,对提取的定量资料进行异质性检验、Meta分析和敏感性分析。结果共检出1362篇文献,最终纳入6项随机对照研究(共1292例患者),研究质量A、B、C级各2项。按需更换静脉留置针组静脉炎发生率高于定期更换静脉留置针组(RR:2.47,95%CI:1.48～4.13);两种静脉留置针更换方式下导管相关血行感染发生率差异无统计学意义(RR:0.96,95%CI:0.19～4.81)。结论静脉留置针按需更换方式较定期更换方式发生静脉炎的风险增大;按需更换方式对导管相关血行感染的发生率没有影响;尚不能肯定按需更换方式是否会影响皮下血肿、液体渗漏、导管堵塞等并发症的发生。

Objective To systematically compare the incidences of complications between routine replacement strategy and clinical indicated replacement strategy of peripheral venous catheter, with a view to identifying the better one. Methods Guided by the principles of evidence-based medicine and the methods of Cochrane systematic reviews, randomized controlled trials or quasi-randomized control trials of replacement strategy of peripheral venous catheter nere couected. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted including homogeneous studies and sensitivity analysis with RevMan 50. 18. Results Six studies （1292 Patients） were included. Two studies were graded A, two were graded B and the other two were graded C. Meta-analysis showed that the incidence of phlebitis of clinical indicated replacement of peripheral venous catheter group was higher than routine replacement group（RR： 2.47,95%CI：1.48-4.13）. The difference of catheter-related blood infection rate between two groups had no statistical significance（RR：0. 96,95%CI：0. 19-4.81）. Conclusion Compared with routine replacement strategy, clinical indicated replacement strategy of peripheral venous catheter may increase the incidence of phlebitis;Clinical indicated replacement strategy doesn＇t affect Catheter-related blood infection rate; Still not sure whether clinical indicated replacement strategy wilt affect the incidences of swelling, infiltration or occlusion.