应用正压接头与肝素帽两种连接PICC方法静脉输注效果的Meta分析

Meta-analysis of effect of positive pressure joint and heparin cap for PICC infusion

[目的]系统评价正压接头与肝素帽两种连接方法对经外周静脉置入中心静脉导管(PICC)的输液效果及影响。[方法]检索EMbase、PubMed、EBSCO全文数据库、万方数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM),搜索自建库至2017年3月对比正压接头与肝素帽两种连接方法对PICC输液效果影响的随机对照试验,按照入选标准严格筛选文献并对文献进行质量评估,对最终入选的文献使用RevMan 5.3软件进行Meta分析。[结果]最终纳入8项研究,研究对象共计1 112例,其中正压接头组527例,肝素帽组585例。Meta分析结果显示,采用正压接头PICC输液效果优于肝素帽接头,差异有统计学意义。正压接头可降低导管内回血、导管堵塞、护理人员扎伤的发生率并延长PICC留置时间(均P<0.05)。[结论]PICC病人采用正压接头进行输液的效果优于肝素帽接头,但由于纳入的研究有限且质量较低,该结论有待更多有价值的、高质量的临床随机对照试验给予验证。

Objective:To systematically compare effect of positive pressure joint and heparin cap for peripherally inserted central venous catheter(PICC)infusion.Methods:Database including EMbase,PubMed,EBSCO,Wanfang Data,CNKI,and CBM were searched from inception to March 2017 to collect the randomized controlled trials(RTCs)about comparison of positive pressure joint and heparin cap for effect of PICC infusion.All literatures were screened strictly according to the standard of admission and evaluated the quality.Software RevMan 5.3 was used to conduct Meta-analysis for all selected literatures.Results:A total of 8 researches involving 1112 cases were included,of which 527 cases in positive pressure joint group,and 585 cases in heparin cap group.Meta-analysis results showed effect of positive pressure joint for PICC infusion was better than that of heparin cap,and differences were statistically significant.Positive pressure joint could reduce intraductal blood recovery[RR=0.21,95%CI(0.12,0.36),P<0.000 01],Catheter blockage[RR=0.29,95%CI(0.20,0.43),P<0.000 01],the incidence of nursing staff injured[RR=0.09,95%CI(0.02,0.40),P=0.001],and prolong PICC lien time[SMD=8.64,95%CI(6.42,10.85),P<0.000 01].Conclusions:The effect of positive pressure joint for PICC infusion was better than that of heparin cap,but due to the limited and poor quality of included studies,the conclusion need to be verified by more valuable and high-quality clinical randomized controlled trials.