成年血液透析患者不同封管液应用效果的网状Meta分析

Effect of various locking solutions for hemodialysis catheters in adults patients:a network meta analysis

目的评估不同封管液对成人血液透析患者的封管效果。方法通过计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普数据库,检索时间为建库至2018年9月。收集不同封管液对血液透析患者封管效果比较的随机对照试验。使用Cochrane 5.1.0系统评价手册进行质量评价,Stata12.0软件绘制网络图,WinBUGS进行数据分析。结果最终纳入文献15篇,包含7种封管液,共计样本量2 159例。网状Meta结果显示,对于导管相关性感染、导管接口处感染以及病死3个结局指标,各个研究结果比较,差异无统计学意义,但就概率排序,对降低导管相关性感染、导管接口处感染以及病死的发生,最优的封管液分别为抗生素、枸橼酸盐和乙醇。结论结合网状Meta分析结果和概率排序,考虑抗生素耐药特性,推荐乙醇或枸橼酸盐作为血液透析患者的封管液。

Objective To evaluate the effect of various locking solutions for hemodialysis catheters in adults patients. Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database were searched to collect randomized controlled trials (RCTs) on usage of different locking solutions to lock the hemodialysis catheters in adult patients, with the publication time being limited to database inception to September,2018. The Cochrane 5.1.0 systematic review manual was used for quality evaluation, the Stata 12.0 software was used to draw the network diagram, and the WinBUGS was used for data analysis. Results A total of 15 publications were included, reporting 8 kinds of locking solutions, with a total sample size of 2 159 cases. The results of network meta analysis showed no statistically significant differences in 3 outcome mea- sures (catheter-related infections, infection at the catheter interface, and death).However, from the probability ranking table, the optimal locking solutions were antibiotics, citrate and ethanol, which were beneficial to the reduction in catheter-related infections, infection at the catheter interface and the occurrence of death. Conclusion Through a combination of the results of network meta analysis and the probability ranking table, given that long-term use of antibiotics can lead to bacterial resistance, ethanol or citrate can be recommended as a sealing solution for hemodialysis patients.