肿瘤化疗病人应用植入式静脉输液港与PICC临床效果的系统评价

Clinical effect of venous-access ports and PICC in patients with tumor chemotherapy:a systematic evaluation

[目的]系统评价植入式静脉输液港(VPA)与经外周静脉穿刺置入中心静脉导管(PICC)在肿瘤化疗病人中的应用效果。[方法]检索Cochrane CDSR、PubMed、EMbase、CINAHL、SCIE、中国生物医学文献服务系统(CBM)、万方数据资源系统及维普期刊资源整合服务平台(VIP)中关于肿瘤化疗病人应用VAP与PICC效果比较的随机对照试验、半随机对照试验、队列研究。由2位研究员按照纳入标准筛选文献、提取资料、评价质量,使用RevMan5.3软件对结局指标进行Meta分析。[结果]共纳入6项随机对照试验、2项半随机对照试验、7项队列研究。经Meta分析,试验组(采用VPA)导管堵塞发生率[相对危险度(RR)=0.26,95%可信区间(CI)(0.15,0.42),P<0.05]、导管感染发生率[RR=0.23,95%CI(0.14,0.38),P<0.05]、静脉炎发生率[RR=0.11,95%CI(0.05,0.25),P<0.05]、导管移位/脱出发生率[RR=0.18,95%CI(0.09,0.39),P<0.05]均显著低于对照组,差异有统计学意义;试验组导管平均留置时间[标准化均方差(SMD)=1.22,95%CI(0.38,2.06),P<0.05]明显优于对照组,差异有统计学意义;但在首次置管成功率方面,两组比较差异无统计学意义(P>0.05)。[结论]VPA较PICC在延长导管留置时间及降低导管堵塞发生率、导管感染发生率、静脉炎发生率、导管移位/脱出发生率方面具有优势,是一种更为安全、有效的静脉通路。

Objective：To systematically review the clinical effect of venous-access ports（VPA/VAP）and peripheral venous catheterization（PICC）in patients with tumor chemotherapy.Methods：Randomized controlled trial（RCT）,semi-randomized controlled trial,and cohort study of comparison the application effect of VAP and PICC in patients with tumor chemotherapy were retrieved from the Cochrane CDSR,PubMed,Embase,CINAHL,SCIE,Chinese biomedical literatures service system（CBM）,Wanfang,and VIP database.According to the inclusion criteria,two researchers selected the literature,extracted the data,and evaluated the quality,and conducted a meta-analysis of the outcome indicators by the RevMan5.3 software.Results：A total of 6 RCTs,2 semi-RCTs,and 7 cohort studies involved 2 061 patients were included in this study.The meta-analysis showed that,the incidence of catheter jam [relative risk（RR）=0.26,95% confidence interval（CI）（0.15,0.42）,P〈0.05],the incidence of catheter infections[RR=0.23,95%CI（0.14,0.38）,P〈0.05],the incidence of phlebitis[RR=0.11,95%CI（0.05,0.25）,P〈0.05],the incidence of catheter shift/out[RR=0.18,95%CI（0.09,0.39）,P〈0.05）of the experimental group（using VAP）were significant lower than those of the control group,the difference was statistically significant.The average catheter indwelling time[standardized mean difference（SMD）=1.22,95%CI（0.38,2.05）,P〈0.05]of the experimental group was significantly better than that of the control group,and the difference was statistically significant.There was no statistically significant difference between the two groups in the success rate of the first catheter（P〉0.05）.Conclusions：Compared with PICC,VPA had advantages on extending the catheter indwelling time,reducing the incidence of catheter blockage,catheter infection,phlebitis,and catheter shift/out,which was a more safe and effective venous pathway.