肝素联合尿激酶用于血液透析患者中心静脉导管封管效果的Meta分析

Meta-analysis of the Effect of Heparin Combined with Urokinase as CVC Locking Solution in Hemodialysis Patients

目的评价肝素联合尿激酶在血液透析患者中心静脉导管封管中的有效性及安全性。方法检索万方数据库、中国知网全文数据库、PubMed、Ovid、Cochrane Library、Embase、Medline中有关肝素联合尿激酶封管与单独使用肝素封管效果的随机对照试验,检索时间为建库至2020年6月。运用Cochrane Handbook对文献质量进行评价,采用RevMan 5.3软件进行Meta分析。结果共纳入8篇研究,涉及患者610例。Meta分析结果显示:肝素联合尿激酶较单独使用肝素封管可有效降低导管相关性感染[RR=0.20, 95%CI(0.09~0.45),P<0.001];提高透析充分性[MD=0.38, 95%CI(0.08~0.70), P<0.001];提高透析血流量[MD=51.13, 95%CI(28.97~73.29), P<0.001];降低导管故障发生率[RR=0.19, 95%CI(0.08~0.46), P<0.001]。结论肝素联合尿激酶封管有助于降低血液透析患者中心静脉导管的感染率,并对提高导管的通畅性及安全性有积极促进作用。

Objective To evaluate the efficacy and safety of heparin combined with urokinase as hemodialysis CVC locking solution.Methods The randomized controlled trials on the locking effect of heparin combined with urokinase and heparin alone were retrieved in Wanfang Data,CNKI,PubMed,Ovid,Cochrane Library,Embase and Medline from database establishment to June 2020.Cochrane Handbook was used to eva-luate the quality of the literatures,and RevMan 5.3 was used for Meta-analysis.Results A total of 8 studies involving 610 patients were included.Meta-analysis showed that heparin combined with urokinase was more effective than heparin alone as locking solution in reducing catheter-related infection[RR=0.20,95%CI(0.09~0.45),P<0.001],improving dialysis adequacy[MD=0.38,95%CI(0.08~0.70),P<0.001],increasing dialysis blood flow[MD=51.13,95%CI(28.97~73.29),P<0.001]and reducing the incidence of catheter dysfunction[RR=0.19,95%CI(0.08~0.46),P<0.001].Conclusion Heparin combined with urokinase as locking solution is effective in reducing CVC infection rate in hemodialysis patients,and promoting catheter patency and safety.