持续肝素输入预防新生儿经外周导入中心静脉置管导管阻塞的Meta分析

Continuous heparin infusion to prevent catheter occlusion in neonates with peripherally inserted central catheter:a Meta analysis

目的:评价持续肝素输入预防新生儿经外周导入中心静脉置管(peripherally inserted central catheter,PICC)导管阻塞的疗效和安全性。方法:计算机检索国内外各主要数据库,同时查阅所检出文献的参考文献及手工检索,收集肝素输入预防新生儿PICC导管阻塞的随机对照试验(randomized controlled trials,RCTs),按Cochrane协作网系统评价的方法进行评价,用RevMan5.1软件做统计分析。结果:共纳入4个RCTs(716例患者),3个试验是空白对照,1个试验用安慰剂对照。Meta分析结果显示,试验组与对照组比较,导管阻塞发生率[相对危险度(risk ratio,RR)0.47,95%置信区间(confident interval,CI)(0.24,0.94),P=0.03]降低和PICC导管通畅时间延长[RR 2.09,95%CI(1.21,2.97),P<0.000 01],但在病死率、导管相关败血症及肝素副作用方面,两组比较差异均无统计学意义。结论:持续肝素输入能预防新生儿PICC导管阻塞和延长导管保持通畅时间,但目前的试验没有足够的效能来评估肝素相关副作用的发生率。

Objective：To assess the efficacy and safety of continuous heparin infusion to prevent catheter occlusion in neonates with peripherally inserted central catheter（PICC）.Methods：Main databases at home and abroad were searched electronically or by hand,the relevant references of selected literatures were looked up and randomized controlled trials（RCTs）,comparing heparin with placebo or blank control in neonates with PICC were collected.Quality assessment was conducted based on the methods recommended by the Cochrane Collaboration and Meta analysis was performed using RevMan 5.1 software.Results：Four RCTs（including 716 participants） were identified;three RCTs were designed as heparin group vs.blank group and one trial as heparin group vs.placebo group.Results of Meta analysis demonstrated that the incidence of catheter occlusion was lower and duration of catheters patency was longer in heparin group than in control group（RR 0.47,95%CI（0.24,0.94）,P=0.03）（RR 2.09,95%CI（1.21,2.97）,P〈0.000 01）,but there was no statistical difference in the risk of mortality,catheter related sepsis and adverse events between the two groups.Conclusions：Continuous heparin infusion can prevent catheter occlusion and lengthen the duration of catheters patency in neonates with PICC,but present trials are not powered enough to evaluate the incidence rates of adverse events.