系统评价我国留置针与静脉穿刺针应用效果和安全性差异

Comparison of efficacy and safety between venous indwelling needle and puncture needle:a Meta-analysis and systematic review

目的:采用循证医学Meta分析方法评价留置针与静脉穿刺针应用效果和安全性差异。方法:计算机检索万方、CNKI、维普和CBM等中文数据库,检索年限自建库至2012年6月,全面收集国内已发表的有关留置针与静脉穿刺针的临床对照研究,由两位研究者分别独立提取数据,汇总数据采用Review Manager5.1.6进行分析,两组之间差异采用优势比(odds ratio,OR)及其95%可信区间(95%confidence interval,95%CI)描述。结果:严格根据纳入和排除标准,最终纳入6个临床对照研究,共计815例研究对象,其中观察组412例均采用留置针,对照组403例均采用静脉穿刺针。Meta分析结果表明:留置针组针头移位率(OR=0.16,95%CI 0.07～0.40,P<0.000 1)、输液渗漏率(OR=0.37,95%CI 0.15～0.59,P=0.000 5)显著低于静脉穿刺针组;留置针组不良反应发生率亦显著低于静脉穿刺针组,包括伤口疼痛发生率(OR=0.29,95%CI 0.13～0.65,P=0.003)、伤口肿胀发生率(OR=0.26,95%CI 0.09～0.72,P=0.009)、静脉炎发生率(OR=0.39,95%CI 0.21～0.72,P=0.003)和肢体淤血淤斑发生率(OR=0.25,95%CI 0.10～0.63,P=0.003)。此外,留置针组患者的护理满意率也高于静脉穿刺针组(OR=9.67,95%CI 3.52～26.60,P<0.000 1)。结论:现有证据表明,留置针临床应用效果及安全性均优于静脉穿刺针,适合临床广泛应用。

Objective： To evaluate the efficacy and safety between venous indwelling needle（VIN） and puncture needle（ VPN ） by conducting a Metaanalysis. Methods： The CBM, Wanfang, VIP and CNKI databases were searched for all articles published up to June ,2012 that addressed the comparison between VIN and VPN. Statistical analyses were performed using RevMan 5.1.6 software. Results： According to inclusion criteria, six clinical controlled studies were retrieved, including 412 patients in VIN group and 403 patients in VPN group. Meta-analysis results showed that there were statistically significant differences between VIN group and VPN group in the rate of needle shift（OR =0. 16,95% CI 0. 07-0.40,P 〈0. 000 1 ） and the rate of infusion leakage（ OR =0. 37,95% CI 0. 15-0. 59 ,P = 0. 000 5 ）. The rate of side effects in VIN group were also lower than that in VPN group, including the incidence of pain（ OR = 0. 29,95% CI 0. 13-0.65, P = 0. 003 ）, the incidence of swelling（ OR = 0. 26,95% CI 0. 09-0. 72 ,P =0. 009） ,the incidence of phlebitis（ OR =0. 39,95% CI 0. 21-0. 72,P =0. 003） ,and the incidence of body passive congestion ecchymoses （ OR = 0.25,95% CI 0. 10- 0.63, P = 0. 003 ）. In addition, the nursing satisfaction in VIN group was also higher than that in VPN group （OR = 0. 25,95% CI 0. 10-0.63, P = 0. 003 ）. Conclusion： Results from the current Meta-analysis suggeste that the efficacy and safety of VIN are better than VPN.