PICC相关感染危险因素的Meta分析

Risk factors for PICC-related infections:a meta-analysis

目的分析PICC相关感染的危险因素,旨在为临床预防导管相关性感染提供依据。方法采用Meta分析的方法对从建库开始至2015年12月为止公开发表的PICC相关感染危险因素的20篇文献进行定量综合分析。结果 PICC相关感染率为16.2%;各因素合并OR值及95%可信区间分别为:年龄≥66岁(4.83,4.16~5.60)、导管留置≥6月(5.03,5.02~5.03)、输注特殊药物(2.15,1.65~2.82)、合并基础疾病(2.98,2.05~4.32)、穿刺≥2次(1.85,1.45~2.35)、化疗>4次(2.23,1.81~2.75)、白细胞减少(2.87,2.31~3.55)、夏冬季节(3.04,1.97~4.67)、操作人员年资<5年(2.26,1.64~3.13)、穿刺经验<50次(2.20,1.71~2.81)、多腔导管(2.55,1.77~3.66)、换药频次>4d(3.28,1.92~5.60)、导管移动(4.47,2.05~9.74)、B超引导(0.92,0.88~0.97)。结论发生PICC相关感染的危险因素为高龄、导管留置时间长、输注特殊药物、合并基础疾病、反复穿刺、多次化疗、白细胞减少、夏冬季节、操作人员年资低、穿刺经验少、多腔导管、换药少及导管移动;保护因素为B超引导下穿刺。

OBJECTIVE To explore the risk factors for PICC-related infections so as to provide guidance for clinical prevention of catheter-related infections. METHODS By means of Meta-analysis, a quantitative and comprehensive analysis was conducted for 20 literatures regarding the risk factors for PICC-related infections that were published from the establishment of database to Dec, 2015. RESULTS The incidence of PICC-related infections was 16.2 %. The OR values of the combined factors were respectively 4.83 （no less than 63 years of age）, 5.03 （catheter in- dwelling no less than 6 months）, 2.15 （infusion of special drugs）, 2.98 （complication with underlying diseases）, 1.85 （no less than two time of puncture）, 2.23 （more than 4 times of chemotherapy）, 2.87 （leucopenia）, 31 04 （summer and winter）, 2.26 （operators~ qualification less than 5 years, 2.20 （experience of puncture less than 50 times）, 2.55 （multi-lumen catheter）, 3.28 （frequency of dressing change more than 4 days）, 4.47 （movement of catheter）, and 0.92 （B-ultrasound guided） ; the 95 % confidence intervals were respectively （4.16-5.60）, （5.02 -5.03）,（1.65-2.82）, （2.05-4.32）, （1.45-2.35）, （1.81-2.75）, （2.31-3.55）, （1.97-4.67）, （1.64-3.13）, （1.71-2.81）,（1.77-3.66）, （1.92-5.60）, （2.05-9.74）, and （0.88-0.97）.CONCLUSION The risk factors for the PICC-related infections include the advanced age, long-term catheter indwelling, infusion of special drugs, complication with underlying diseases, repeated puncture, frequent chemotherapy, leucopenia, summer and winter, less qualification and experience of puncture, multi-lumen catheter, less drug dressing change and movement of catheter. The B ultrasound-guided puncture is a protective factor.