枸橼酸钠对比肝素封管液对血液透析导管维护有效性的Meta分析

Effectiveness of Sodium Citrate Solution and Heparin in Maintenance of Hemodialysis Catheters:A Meta Analysis

目的评价枸橼酸钠封管液与肝素封管液在血液透析导管维护中的有效性。方法检索The Cochrane Library、Web of Science、CINAHL Complete、PubMed、中国知网、维普和万方数据库,手工检索《American Journal of Kidney Diseases Home》《中华肾脏病杂志》、《肾脏病透析与肾移植杂志》符合纳入标准的随机对照试验或类试验,检索时限均为建库至2018年2月3日。使用Revman 5.0和STATA 12进行Meta分析。结果纳入15项研究(1 485例患者),结果显示枸橼钠封管液在减少出血发生率[RR=0.22, 95%CI(0.12,0.41),P<0.01]、溶栓治疗次数[RR=0.74, 95%CI(0.60,0.91),P<0.01]方面明显优于肝素封管液;2组在导管感染的指标上发现不同统计单位出现相反的结果;在血栓发生率、功能障碍导致拔管率及死亡率指标上的对比差异无统计学意义(P>0.5)。结论枸橼酸钠对比肝素封管液可降低出血发生率、溶栓治疗次数,中等浓度的枸橼酸钠封管液可以明显减少导管感染的发生。2组在减少血栓发生率、功能障碍导致拔管率及死亡率方面无明显差异。

Objective To evaluate the efficacy of sodium citrate solution and heparin in the maintenance of hemodialysis catheters.Methods We searched literatures in The Cochrane Library,Web of Science,CINAHL Complete,PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Database,Chinese Science and Technology periodical Database(VIP)from their inception to February 3,2018 and papers from American Journal of Kidney Diseases Home,Chinese Journal of Kidney Diseases,and Kidney Dialysis and Kidney Transplant Journal from their first issue to February 3,2018.Only randomized controlled trials(RCT)or quasi-experimental trials published in full-text papers were included.Revman 5.0 and Stata 12.0 software were used for meta analysis.Result Fifteen studies(1,485 patients)were included.The results indicated that the citrate sealing solution was obviously superior to the heparin sealing solution in reducing the incidence of bleeding[RR=0.22,95%CI(0.12,0.41),P<0.01]and the frequency of thrombolytic therapy[RR=0.74,95%CI(0.60,0.91),P<0.01].We found the opposite results in the catheter infection between the two groups with different statistical units.There was no statistical significance in the comparison of the rate of thrombus occurrence,dysfunction resulting in extubation rate and mortality(P >0.5).Conclusion Compared with heparin,sodium citrate can reduce the incidence of hemorrhage and the times of thrombolytic therapy.Sodium citrate with medium solubility can obviously reduce the incidence of catheter infection.There is no significant difference in the rate of thrombus,extubation due to dysfunction,and mortality between the two groups.