PICC带管出院患者居家维护的可行性Meta分析

Maintenance of PICC line in the home: a meta-analysis

目的比较经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)带管出院患者居家维护和返院维护的效果,评价居家维护方式的可行性。方法通过计算机检索Cochrane Library、Pub Med、Embase、中国期刊全文数据库(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库中收集2016年8月以前国内外公开发表的关于PICC带管出院患者返院维护与居家维护效果比较的临床试验,采用Stata 12.0软件对资料进行Meta分析,结局指标是PICC相关并发症的发生率。结果共纳入15篇文献,全体样本量共计1 374例患者,其中返院维护组730例患者,居家维护组644例患者。Meta分析结果显示:居家维护组的局部感染率[RR=3.82,95%CI(2.51~5.83)]、静脉炎发生率[RR=5.51,95%CI(2.08~14.61)]、导管脱出率[RR=2.36,95%CI(1.28~4.34)]、导管堵塞率[RR=1.75,95%CI(1.26~2.43)]、血栓形成率[RR=3.77,95%CI(1.30~10.90)]低于返院维护组;居家维护组的导管相关性感染率[RR=0.93,95%CI(0.57~1.53)]、导管破损率[RR=0.58,95%CI(0.15~2.27)]、皮肤过敏率[RR=1.08,95%CI(0.36~3.28)]与返院维护组比较,差异无统计学意义。结论当前临床证据表明:与返院维护方式比较,PICC带管出院患者采用居家维护方式不会使PICC相关并发症的发生率增高,该维护方式是可行的。

Objective To compare the effectiveness of home maintenance and hospital maintenance of peripherally inserted central catheter（PICC） line in outpatients and evaluate the feasibility of maintenance in the home. Methods We searched Cochrane Library, PubMed, Embase, CNKI, VIP, CBM, Wanfang database by computer to collect clinical con- trolled trials that were published at home and abroad before August 2016 on the effectiveness of home maintenance and hospital maintenance in patients with PICC. Stata 12 software was used for Meta-analysis of the data. The incidence of PICC related complications was used as outcome indicator. Results A total of 15 papers were included,with a total sample size of 1374 patients, of which 730 patients in the hospital maintenance group,644 patients in the home maintenance group. The results of Meta-analysis showed that the rate of local infection[ RR = 3.82,95% CI（2.51 - 5.83 ） ], phlebitis [ RR = 5.51,95% CI（2.08 - 14.61 ） ], catheter removal [ RR = 2.36,95 % CI（ 1.28 - 4.34 ） ], catheter blockage [ RR = 1.75,95 % CI（ 1.26 - 2.43 ） ] and catheter-related thrombosis [ RR = 3.77,95 % CI（ 1.30 - 10.90） ] in the home maintenance group were lower than that in the hospital maintenance group ; compared with the hospital maintenance group, the rate of catheter related infection [ RR = 0.93,95 % CI （ 0. 57 - 1.53 ） ], catheter breakage [ RR = 0.58,95 % CI （ 0. 15 - 2.27） ], skin allergy[ RR = 1.08,95% CI（0. 36 - 3.28 ） ] in the home maintenance group were not statistically significant. Conclusion The current clinical research evidence suggests that the home maintenance method in outpatients with PICC cannot increase the rate of PICC related complications compared with the method of the hospital maintenance, and the home maintenance method is feasible.