临床护理路径在经外周置入中心静脉导管病人中应用效果的系统评价

Application effect of clinical nursing pathways in patients with peripherally inserted central catheter: a systematic review

目的采用系统评价的方法探讨临床护理路径在经外周置入中心静脉导管(PICC)病人的应用效果。方法计算机检索中国知网(CNKI)、维普网(VIP)、万方数据库(Wan Fang Data)、中国生物医学文献数据库(CBM)、Pub Med、EMbase和The Cochrane Library(2016年第10期),收集关于临床护理路径应用于PICC病人的随机对照试验,检索时限均为建库至2016年10月。由两位评价者按照纳入与排除标准独立进行资料提取,并根据Cochrane Handbook 5.1.0评价纳入研究质量后,采用Rev Man 5.1软件进行Meta分析。结果最终纳入12个研究,共1 572例病人。Meta分析结果显示:临床护理路径在提高PICC病人的一次性穿刺成功率(RR=1.12,95%CI:1.07~1.18,P<0.000 01)和留置时间(MD=16.20,95%CI:3.10~29.30,P=0.02)以及降低并发症的发生情况(堵管(RR=0.30,95%CI:0.16~0.54,P<0.000 1)、静脉炎(RR=0.36,95%CI:0.20~0.67,P=0.001)、导管相关性感染(RR=0.31,95%CI:0.19~0.49,P<0.000 01)、导管脱落(RR=0.23,95%CI:0.09~0.61,P=0.003)、穿刺点渗血(RR=0.23,95%CI:0.07~0.71,P=0.01)优于对照组,其差异有统计学意义;但在对血栓(RR=0.20,95%CI:0.02~1.85,P=0.16)影响方面差异无统计学意义。结论 PICC病人实施临床护理路径,不仅能提高一次性穿刺成功率和留置时间,还有助于降低并发症的发生率。

Objective To evaluate the application effect of clinical nursing pathways in patients with peripherally inserted central catheter by using a meta-analysis.Methods Search was conducted in the following databases:CNKI,VIP,Wan Fang Data,CBM,Pub Med,EMbase and The Cochrane Library during the period from the established time to October 2016.Randomized controlled trial(RCT) of clinical nursing pathways in patients with peripherally inserted central catheter were included.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data and assessed the quality of the included studies according to Cochrane Methods 5.1 for Systematic Review,and meta-analysis was conducted by Rev Man 5.1 software.Results A total of 12 studies involving 1 572 patients were included.Meta-analyses showed that clinical nursing pathways were superior in one-time success rates of puncture(RR=1.12,95% CI:1.07-1.18,P<0.000 01) and retained time(MD=16.20,95% CI:3.10-29.30,P=0.02),and reducing the incidences of complications including catheter occlusion(RR=0.30,95% CI:0.16-0.54,P<0.000 1),phlebitis(RR=0.36,95% CI:0.20-0.67,P<0.000 1),catheter-related infection(RR=0.31,95% CI:0.19-0.49,P<0.000 01),catheter prolapse(RR=0.23,95% CI:0.09-0.61,P=0.003) and puncture site bleeding(RR=0.23,95% CI:0.07-0.71,P=0.01),with statistically significant differences.However,there was no statistically difference in thrombosis(RR=0.20,95% CI:0.02-1.85,P=0.16) between the two groups.Conclusion Application of clinical nursing pathways in patients with peripherally inserted central catheter could improve one-time success rate of puncture and retained time,and it is also beneficial in lowing the incidences of complications.