新生儿外周静脉置入中心静脉导管相关性感染危险因素的荟萃分析

Risk factors of peripherally inserted central catheter-related infections inneonates:a meta-analysis

目的综合评价新生儿经外周静脉置入中心静脉导管(PICC)相关感染的危险因素及关联强度,为临床预防新生儿PICC相关性感染提供循证依据。方法通过计算机检索中国知网、维普、万方、中国生物医学、PubMed、Embase、The Cochrane Library数据库截至时间到2018年12月31日关于新生儿PICC相关性感染危险因素的文献,并辅以手工检索和文献追溯法,按纳入和排除标准由2名研究者独立对文献进行筛选、资料提取和质量评价后运用RevMan 5.2进行分析。结果最终纳入文献11篇,PICC感染率为5.91%。各因素合并OR值及95%可信区间分别为:穿刺次数≥2次(OR=23.71,95%CI:6.28~89.48)、穿刺时间>30 min(OR=23.65,95%CI:6.09~91.83)、导管堵管(OR=71.72,95%CI:17.05~301.64)、导管插入场所(OR=3.63,95%CI:2.17~6.08)、非计划拔管(OR=42.17,95%CI:23.36~76.11)、胎龄<37周(OR=4.17,95%CI:1.55~11.21)、置管时间>10 d(OR=1.53,95%CI:1.21~1.94),各危险因素感染组与非感染组差异有统计学意义(均P<0.05)。结论穿刺次数≥2次、穿刺时间>30 min、导管堵管、导管插入场所(新生儿ICU)、非计划拔管、胎龄<37周、置管时间>10 d是新生儿患者发生PICC相关性感染危险因素。医护人员应该对以上高危因素进行重点关注,采取有针对性的措施降低感染的发生率。

Objective To critically evaluate the risk factors for peripherally inserted central catheter(PICC)-related infections in neonates for the purpose to improve evidence-based prevention of catheter-related infections in neonates.Methods Literatures published between the establishment of database and December 31,2018 were retrieved from CNKI,VIP,Wanfang,CBM,PubMed,Embase,and the Cochrane Library regarding catheter-related infections in neonates.Manual search and document traceability were carried out to find more relevant studies.The literatures were screened by two researchers independently according to the inclusion and exclusion criteria.Data extraction and meta-analysis were conducted using software RevMan 5.2.Results A total of 11 articles were included.The incidence of PICC-related infections was 5.91%.The combined OR values and corresponding 95%confidence intervals were provided for the following factors:puncture≥2 times(OR=23.71,95%CI:6.28~89.48),puncture proceure>30 minutes(OR=23.65,95%CI:6.09~91.83),catheter blockage(OR=71.72,95%CI:17.05~301.64),catheter insertion setting(OR=3.63,95%CI:2.17~6.08),unscheduled extubation(OR=42.17,95%CI:23.36~76.11),gestational age<37 weeks(OR=4.17,95%CI:1.55~11.21),and duration of indwelling catheter>10 days(OR=1.53,95%CI:1.21~1.94).These factors showed statistically significant difference between groups(P<0.05).Conclusions The significant risk factors for PICC-related infections in neonates include puncture≥2 times,puncture proceure>30 minutes,catheter blockage,catheter insertion setting,unscheduled extubation,gestational age<37 weeks,and duration of indwelling catheter>10 days.Medical staff should pay more attention to the above factors and take specific preventive measures to reduce the incidence of neonatal PICC-related infections.