单纯枸橼酸和肝素封管液预防血液透析长期留置导管相关并发症的Meta分析

Single citrate locksolution versus heparin lock solution for the prevention of complicationsassociated with long-term dwelling catheter in hemodialysis patients: a meta-analysis

目的采用Meta分析的方法比较单纯枸橼酸和肝素封管液预防血液透析长期留置导管相关并发症的效果。方法计算机检索Cochranelibrary、PubMed、EMBASE、Medline、Ovid、维普、万方、知网、CBM等数据库,检索时间从建库至2018年9月。检索比较单纯枸橼酸和肝素封管液预防血液透析长期留置导管相关并发症的前瞻性随机对照试验。按Cochrane系统评价的方法评价纳入研究质量,提取数据后用RevMan5.3软件进行Meta分析。结果纳入10个随机对照试验,共1326名患者,实验组674例,对照组647例。实验组留置导管45090d,对照组留置导管43031d。其中3篇研究比较高浓度枸橼酸与肝素封管液的差异,其余7篇的枸橼酸则为中低浓度。Meta分析结果显示:与肝素封管液相比,单纯枸橼酸封管液用于血液透析长期留置导管的患者可减少出血风险[RR=0.33,95%CI(0.25~0.45),P<0.05],但导管内形成血栓风险则较高[RR=1.90,95%CI(1.60~2.25),P<0.05]。而导管相关性血流感染、穿刺部位感染、导管功能障碍、溶栓次数、导管相关性住院及全因死亡率两者差异无统计学意义(P>0.05)。结论现有证据表明,单纯枸橼酸封管液用于血液透析长期留置导管的患者较肝素封管液能降低出血风险,但导管内血栓形成风险较高。因纳入文献的样本量有限及质量不高,上述结论需要高质量、大样本的前瞻性随机对照试验来提供更好的循证证据。

Objective To compare effectiveness of single citrate lock solution versus heparin lock solution for prevention of complicationsassociated with long-term dwelling catheter in hemodialysis patients with Meta-analysis. Methods Comprehensive electronic search was performed using the following electronic databases: Cochrane library, PubMed, EMBASE, Ovid, VIP,Wan Fang, CNKI and CBM. The literature published before September of 2018 was searched. The randomized controlled trials (RCTs) on single citrate lock solution and heparin lock solution in hemodialysis patients were included. The included trials were evaluated for their quality with Cochrane systematic evaluation method, and software RevMan5.3 was used to conduct meta-analysis after extraction of the data. Results Ten randomized controlled trials were included with a total of 1 326 patients which were divided into the trial group (674 patients) and the control group (647 patients). The trail group had catheter dwelling days of 45 090, and the control group had the days of 43 031. High concentration citrate and heparin lock solutions were compared in three trials, middle and low concentrations of the two lock solutions in the resting seven trials. The meta-analysis showed, compared with those on heparin lock solution, the risk for bleeding in patients receiving citrate lock solution decreased,[ RR =0.33, 95% CI (0.25~ 0.45 ), P <0.05],and the risk for catheter thrombosis in the citrate lock solution group was increased significantly[ RR =1.90, 95% CI (1.60 -2.25), P <0.05]. However, both of the groups were similar in terms of catheter-associatedbloodstreaminfection, puncture site infection, catheter dysfunction, thrombolysis treatment frequency, catheter- associated hospitalization and all-cause death, with no difference of statistical significance ( P >0.05). Conclusions According to current evidence,citrate lock solution for hemodialysis patients with tunneled catheter can reduce risk for bleeding, but have higher risk for catheter thrombosis . Because of the limitation of samples and poor quality, more large samples and high quality randomized controlled prospective trials are required to provide better confirmation evidence, so as to support the above conclusion.