植入式静脉输液港与经外周静脉穿刺中心静脉置管在肿瘤化疗中的应用效果评价

A comparative research of venous port access and peripherally inserted central catheter in cancer chemotherapy

目的系统评价植入式静脉输液港（VPA）与经外周静脉穿刺中心静脉置管（PICC）在恶性肿瘤患者化疗中应用的相关研究，分析2种置管方式在临床应用中的差异。方法计算机检索PubMed、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库、维普期刊全文数据库（VIP），按Cochrane系统评价方法筛选文献、评价质量、提取资料，并用RevMan5．2软件进行Meta分析。结果纳入29项研究，共4449例患者，其中实验组1912例（采用VPA），对照组2537例（采用PICC）。实验组导管平均留置时间【标准化均数差（SMD）=3．36，95％可信区间（CI）2．51-4．21，P〈0．011、生命质量[相对危险度（RR）：1．61，95％CI1．15～2．24，P〈0．01]均明显优于对照组，差异有统计学意义；实验组并发症总发生率（RR=0．26，95％C10．20～0．34，P〈0．01）、静脉炎发生率（RR=0．08，95％C10．04～0．16．P〈0．01）、导管感染发生率（RR=O．32，95％C10．23～0．44，P〈0．01）、导管堵塞发生率（RR=0．32，95％C10．22-0．48，P〈0．01）、导管移位发生率（RR=0．18，95％C10．09～0．37，P〈0．01）均显著低于对照组，但在首次置管成功率、渗血或血肿发生率、血栓发生率、导管渗漏发生率方面，2组比较差异无统计学意义，P〉0．05。结论与PICC相比，VPA留置时间长，并发症发生率低，且对患者带管期间的生命质量影响较小，在恶性肿瘤患者的化学治疗中值得广泛推广。

Objective To analyze the difference of the venous port access （VPA） and peripherally inserted central catheter （PICC） in cancer chemotherapy. Methods All eligible studies on VPA and PICC were searched in the databases of PubMed, China National Knowledge Internet （CNKI）, Chinese Biomedical Database （CBM）,WANFANG Database and VIP Database. Literatures screening, quality evaluation and data extraction were conducted according to Cochrane Handbook; Meta- analysis was calculated by using RevMan 5.2. Results Twenty-nine studies with a total of 4 449 cases of patients were included in this Meta-analysis, with 1 912 cases in experimental group which adopted VPA and 2 537 cases in controlled group which adopted PICC. Experimental group had advantages in the average catheter retention time （SMD=3.36, 95%CI 2.51-4.21） and quality of life （RR=1.61, 95%CI 1.15-2.24） compared with controlled group. The overall complication rate （RR=0.26, 95%CI 0.20-0.34, P〈0.01）, phlebitis incidence （RR=0.08, 95%CI 0.04-0.16, P〈0.01）, catheter infection incidence （RR=0.32, 95%CI 0.23-0.44, P〈0.01）, catheter obstruction incidence （RR=0.32, 95%CI 0.22-0.48, P〈0.01）, catheter dystopy incidence （RR=0.18, 95%CI 0.09-0.37, P〈0.01） in experimental group were remarkably lower than that in controlled group. However, no significant difference was found between the two groups in the incidence of the puncture success rate for the first time, errhysis or hematoneus, thrombus and catheter leakage （P 〉0.05）. Conehlsious Compared with PICC, VPA had advantages in a long retention time, fewer complications and few influence on quality of life. Therefore, VPA should be widely used in caneer chemotherapy.