肝素预防肿瘤患者PICC堵管的系统评价

System evaluation of heparin to prevent tumor chemotherapy in patients with PICCcatheter obstruction

目的系统评价肝素封管预防肿瘤患者PICC堵管的效果,给出最佳推荐肝素浓度,为临床PICC维护提供循证护理证据。方法计算机检索Pub Med数据库、Cochrane图书馆、CNKI、CBM等电子数据库。应用Rev Man5.2统计学软件进行数据分析。结果纳入6篇中文文献,Meta分析显示PICC应用肝素封管时,导管堵管的发生率是生理盐水的0.15倍[RR=0.15,95%CI(0.08,0.27),Z=6.05,P<0.0001];应用50u/m L肝素封管与生理盐水相比,结果显示差异有统计学意义,P<0.05;62.5 u/m L肝素与生理盐水、尿激酶,都能起到预防导管堵管的作用,差异无统计学意义,P>0.05;应用125u/m L肝素封管,导管堵管的发生率是其他封管液(生理盐水、50u/m L肝素)的0.39倍[RR=0.39,95%CI(0.27,0.570),Z=4.80,P<0.00001]。结论肝素能够起到预防PICC堵管的作用,且效果优于生理盐水(即预冲液);单个应用50u/m L或125u/m L肝素,效果均优于相对应的对照组其他封管液;62.5u/m L的肝素与生理盐水、尿激酶,都能预防导管堵管,且效果相当;125u/m L的肝素预防PICC堵管效果最佳。

Objective To evaluate the effect of PICC on the prevention of tumor patients and provide evidence for clinical PICC maintenance, and provided evidence - based nursing evidence for clinical PICC catheter nursing. Methods Computer retrieval PUBMED, the Coehrane library, China national knowledge infrastructure（ CNKI）, Chinese bio- medical literature database （CBM）. Using RevManS. 2 statistical software for meta analysis. Results 6 Chinese papers were selected in the research. Meta analysis results showed that heparin in patients with tumor in PICC, the incidence of blocking pipe was 0.15 times of normal saline [ RR = 0.15, 95% CI （0.08, 0.08 ）, Z = 6.05, P 〈 0. 0001 ] ; Application of 50u/mL heparin seal tube compared with normal saline, the results showed that the difference was statistically significant, P 〈 0.05 ;62.5u/mL of heparin with normal saline, urokinase, can play the role of prevention of catheter tube jam, P 〉0. 05;Application of 125 u/mL heparin sealing tube, catheter, the incidence of blocking pipe was other liquid seal tube （physiological saline, heparin 50 u/mL） of 0.39 times [ RR = O. 39, 95% CI （0.27, 0. 27）, Z = 4.80, P 〈 0. 00001 ]. Conclusion heparin can play a role in preventing the blockage of PICC, and the effect is better than that of normal saline; single application 50u/mL or 125u/mL heparin, the effect is better than that of the control group; 62.5u/mL heparin and saline, urokinase, can prevent catheter blockage, and the effect is equal; 125u/mL heparin prevention PICC plugging effect is best.