经外周静脉穿刺中心静脉置管与植入式静脉输液港在化疗患者中应用效果的系统评价

Application Effects of Peripherally Inserted Central Catheter and Venous Port Access in Patients with Chemotherapy:A Systematic Review

目的 系统评价经外周静脉穿刺中心静脉置管（peripherally inserted central catheter,PICC）与植入式静脉输液港（venous port access,VPA）两种中心静脉置管方式在化疗患者治疗中应用的差异。方法 全面检索Cochrane、JBI、PubMed、EMBASE、CINAHL、CBM、维普等数据库,收集所有讨论PICC与VPA对化疗患者应用效果的随机对照试验（randomized controlled trial,RCT）、受控的临床试验（controlled clinical trial,CCT）和队列研究,按照JBI文献评价标准对文献进行质量评价,使用RevMan 5.3进行Meta分析或描述性分析。结果 共纳入13篇文献。研究结果显示PICC导管留置时间低于VPA（RR：9.06,95%CI：5.82~14.09）;PICC一次性置管成功率高于VPA,但其差别无统计学意义（RR：0.97,95%CI：0.92~1.03）,P〈0.05;PICC并发症发生率大于VPA（RR：0.30,95%CI：0.22~0.41）,P〈0.05;描述性分析显示VPA组生活质量优于PICC组,且留置时间大于1年时,VPA的总费用低于PICC。结论 VPA与PICC相比,并发症发生率低,留置时间长,患者生活质量高,且维护成本相对较低。但由于高质量文献较少,仍需进一步论证研究。

Objective To systematically evaluate the difference of the peripherally inserted central catheter （PICC） and venous port access （VPA） in patients with chemotherapy.Methods All randomized controlled trials （RCT）, controlled clinical trials（CCT） and cohort studies on PICC and VPA were retrieved from the database of Coehrane,JBI,PubMed,EMBASE,CINAHL,CBM and VIP. The JBI evaluation criteria were used for quality assessment of all the included studies. The meta-analysis was conducted with RevMan5.3 software or descriptive study.Results Thirteen studies were included. The results of meta-analysis showed that retention time of PICC group was less than VPA group（RR ：9.06,95 %CI：5.82~14.09） .The one-time success rate of catheterization in PICC group was higher than VPA group, with no statistical significance （RR： 0. 97,95% CI：0.92 ~ 1.03） （P 〈0.05）. The incidence of complications in PICC group was higher than VPA group（RR .0.30,95 %CI.0.22~0.41） （P〈0.05）. The descriptive analysis showed that the quality of life in VPA group was better than PICC group, and the total cost of VPA group was lower than PICC group when the catheters were retained for more than one year.Conclusions Compared with PICC,VPA is superior in fewer incidences of complications, longer indwelling time, higher quality of life, and cost efficiency. However,it is necessary to verify and pursue further researches due to the lack of high-quality studies.