新生儿不同静脉置入PICC效果的Meta分析

Meta analysis of the effect of PICC in different vein of newborn

目的评价新生儿经上肢和下肢静脉置入PICC的效果。方法计算机检索中国期刊全文数据库(CNKI)、万方数据知识服务平台、中国维普全文数据库(VIP)、中国生物医学文献数据库(CBM)、Cochrane图书馆、Web of Science、PubMed和Science direct中关于上肢和下肢静脉置入外周中心静脉导管的随机对照试验。由2名评价者按照2011年Cochrane手册质量标准,独立评价并交叉核对纳入研究的质量。用RevMan 5.3软件进行统计处理。结果共纳入11篇随机对照试验,样本量1 266例。Meta分析结果显示:与上肢静脉相比,经下肢静脉置入PICC一次性穿刺成功率高、导管异位率低、操作时间短、出血量少,差异有统计学意义(P<0.05);导管感染、外渗发生率低,留置时间长,差异有统计学意义(P<0.05);导管堵塞、静脉炎发生率差异无统计学意义(P>0.05)。结论新生儿经下肢静脉置入PICC有一定的优势,可将下肢静脉作为新生儿PICC穿刺时常规选择静脉。

Objective To evaluate the effect of peripheral central venous catheter insertion through upper and lower limb veins in neonates. Methods The randomized controlled trials of peripheral central venous catheter placement in upper limb vein and lower limb vein were retrieved from CNKI, Wanfang Data Knowledge Service Platform, VIP, CBM, Cochrane Library, Web of Science, PubMed and Science Direct. Two evaluator was independently evaluated and cross-checked. The quality of the included studies according to the quality criteria of the Cochrane Manual in 2011. RevMan 5.3 software was used for statistical processing. Results A total of 11 randomized controlled trials were included. The meta-analysis results showed that: compared with the upper limb vein, PICC through lower limb vein had higher success rate, shorter operation time and less bleeding, and the difference was statistically significant(P<0.05);The incidence of catheter ectopia, infection and exosmosis was low, the indwelling time was long, and the difference was statistically significant;there was no statistical difference in catheter obstruction and phlebitis(P>0.05). Conclusion Lower extremity venous catheterization is superior to upper extremity venous catheterization. It is suggested that lower extremity venous catheterization should be used as a routine choice for neonatal PICC puncture.