基于微信的延续护理对肿瘤患者院外PICC导管并发症效果的Meta分析

Effect of continuing care based on WeChat in prevention of peripherally inserted venous central catheter in patients with cancers:a Meta-analysis

目的:系统确定基于微信的延续性护理策略对预防肿瘤患者院外外周中心静脉置管(peripherally inser ted venous central catheter,PICC)导管并发症是否有效。方法:利用既定的关键词在网上系统检索中英文数据库:万方、维普、Pub Med、Web of Science等,纳入基于微信的延续性护理策略干预肿瘤患者院外PICC导管并发症的相关临床研究,2位研究者各自独立执行文献查阅及筛选任务,以预先确定好的、标准化的数据提取格式提取有关数据,并对纳入的文献进行方法学质量评价,采用Review manager 5.3软件进行相关指标数据的Meta分析,计算合并的比值比(odds ratio,OR)值及其95%可信区间(conf idence inter val,CI),根据纳入研究的数目选择是否进行发表偏倚的检测。结果:共纳入6项研究,共计678例行肿瘤院外PICC导管的患者纳入分析。Meta分析结果示:基于微信的延续性护理策略能有效降低肿瘤患者院外PICC导管并发症的导管脱出发生率(OR=0.25,95%CI 0.08~0.77,P<0.001)、导管相关感染发生率(OR=0.25,95%CI 0.11~0.59,P<0.0 0 1)、静脉炎发生率(O R=0.2 3,9 5%CI 0.0 6~0.9 1,P<0.0 0 1)、皮肤过敏发生率(O R=0.2 7,95%CI 0.08~0.86,P<0.001)、血栓形成发生率(OR=0.28,95%CI 0.14~0.56,P<0.001)。合并的各研究间未见明显的统计学异质性。结论:给予肿瘤患者院外PICC置管患者微信基础上的延续性护理能够降低大部分PICC导管并发症,建议临床推广运用。

Objective： To evaluate the effect of continuing care on WeChat in prevention of peripherally inserted venous central catheter （PICC） in patients with cancer. Methods： Electronic databases including periodical full text database of science and technology in China, periodical full text database in China, Wanfang Database, Weipu Database, PubMed, and Web of Science were searched and two independent reviewers identified relevant parallel trials, assessed trial quality and extracted data. Review Manager （version 5.3） was applied to conduct a meta-analysis of the extracted data to obtain the value of odds ratio （OR） and their 95% confidence interval （CI）. The checking of the publication bias was conducted according to the number of studies. Results： There were six studies having altogether 678 cancer patients with PICC included. There was significant difference on the incidence of catheter extrusion （OR=0.25, 95% CI 0.08–0.77, P〈0.001）, catheter-related infection （OR=0.25, 95% CI 0.11–0.59, P〈0.001）, phlebophlogosis （OR=0.23, 95% CI 0.06–0.91, P〈0.001）, skin allergy （OR=0.27, 95% CI 0.08–0.86, P〈0.001）, and thrombogenesis （OR=0.28, 95% CI 0.14–0.56, P〈0.001）, in the treatment group compared to control group. Conclusion： The existing data supported that continuing nursing care can significantly reduce the occurrence rate of complication of PICC in cancer patients.