抗生素封管对血液透析用带隧道带涤纶套中心静脉导管预后影响的Meta分析

Meta-Analysis of Influence of antibiotic locking solution on the prognosis of tunneled cuffed catheter used in hemodialysis

目的:系统评价抗生素封管方法对于血液透析用带隧道带涤纶套导管中心静脉导管(tunneled cuffed catheter,TCC)预后的影响。方法:用计算机检索Pub Med、Med Line、The Cochran Library、Embase、CNKI和Wan Fang Date,查找有关TCC封管方法的RCT,观察组的封管方法为抗生素+5 000 IU/m L肝素的混合封管液,对照组为5 000 IU/m L肝素封管液,采用Rev Man 5.3软件进行Meta分析。结果:纳入8个RCT共653例TCC,1 000导管日感染发生率两组比较差异有统计学意义(P<0.01);血栓形成率、导管功能不良发生率和封管液相关不良事件比较差异均无统计学意义(P>0.01)。结论:血液透析用带隧道带涤纶套中心静脉导管应用抗生素与肝素的混合液封管能够明显降低患者导管相关性感染发生;在血栓形成、导管功能不良、每例TCC平均使用时间以及封管液相关不良事件发生率方面尚不能得出确切结论,需要高质量的RCT进一步研究。

Objective： To systematically evaluate the influence of antibiotic locking solution on the prognosis of tunneled cuffed catheter（TCC） used in hemodialysis. Methods： Databases including Pub Med,Med Line,The Cochrane Library,Embase,CNKI and Wan Fang Date were used for randomized controlled trial（RCT） about the influence of using antibiotic locking solution versus heparin on TCC. The observation group were treated with the locking solution of mixed antibiotics ＋ 5000 IU/m L heparin while the control group were treated with 5000 IU/m L heparin locking solution,with meta-analysis conducted using Rev Man 5.3 software. Results：A total of 8 studies involving 653 TCC showed that CRI/1000 catheter days was statistically significant between the two groups（P〉0.01）,but there was no difference in the rate of thrombosis,the incidence of catheter dysfunction and the locking related adverse events（P 0. 01）. Conclusion： Hemodialysis with TCC using the locking solution of mixed antibiotics and heparin can significantly reduce the rates of catheter related infection（CRI）. No definite conclusion can be drawn as to thrombosis,catheter dysfunction,the average time of TCC and locking related adverse events,which needs further high quality study on RCT.