两种动静脉内瘘穿刺方法对血液透析患者影响的Meta分析

Meta-analysis for the effects of two methods of cannulation technique for patients with maintenance hemodialysis

目的就绳梯式穿刺法及纽扣式穿刺法对维持性血液透析患者的影响进行Meta分析。方法计算机检索Cochrane library、PubMed、Web of Science、CBM、万方、CNKI等国内外数据库中有关穿刺方法对维持性血液透析患者动静脉内瘘影响的随机对照试验。按照一定的纳入和排除标准选取文献,采用RevMan 5.3软件对选取的文献进行统计分析。结果最终纳入7项随机对照试验,Meta分析结果显示:绳梯式穿刺法引起的疼痛[OR=2.69,95%CI(1.24,5.83),P<0.05]、动静脉内瘘假性血管瘤的发生风险[OR=0.09,95%CI(0.39,7.66),P<0.05]与纽扣式穿刺法相比,差异有统计学意义。因穿刺部位血肿和感染指标分析存在异质性,且合并效应量检验结果显示合并效应量无效(P>0.05),仅采用定性描述分析。结论绳梯式穿刺法和纽扣式穿刺法对动静脉內瘘穿刺患者影响相当。由于评价指标间存在异质性,且不同指标上纳入合格的研究数目也不足,因此,需要更多大样本、高质量的研究进一步评价此两种动静脉内瘘的穿刺方法对血液透析患者的影响。

Objective To study the effect of buttonhole cannulation and rope-ladder cannulation on patients with maintenance hemodialysis through Meta-analysis.Method Randomized controlled trail about the theme have been searched in several databeses including Cochrane library,PubMed,Web of Science,CBM,CHINAINFO,CNKI,et al.The studies that met inclusion criteria were analyzed by using RevMan 5.3.Results 7studies were chosen.The results of meta-analysis were as follows：significant differences were observed in pain and hemangioma between two groups：pian[OR=2.69,95%CI（1.24,5.83）,P〈0.05],hemangioma [OR=0.09,95%CI（0.39,7.66）,P〈0.05].Because of the heterogeneity of indicators in hematomas and infection,besides the result of test of combined effect sizes is unavailability（P〉0.05）.The two indicators were analyzed by using qualitative description.Conclusion The effects of two groups are similar.Because of the heterogeneity of indicators and inadequate included studies,more large sample size and high-quality studies are needed.