经三种路径置入CVC发生导管相关性血流感染的风险:一项系统评价和Meta分析

Risk of Catheter-Associated Bloodstream Infection in CVC Implanted via Three Pathways:A Systematic Review and Meta-Analysis

目的系统评价ICU患者安置在股静脉与锁骨下静脉及颈内静脉的中心静脉导管的导管相关性血流感染(CRBSI)及导管病原菌定植的风险。方法系统检索相关的随机对照研究及观察性研究,并使用RevMan5.3软件进行Meta分析。结果通过系统的文献检索,得到可能相关的文献834篇,经过筛选后最后纳入11篇文献。Meta分析结果:股静脉导管发生CRBSI及导管病原菌定植的风险均高于锁骨下静脉(P=0.0002,P<0.00001),但与颈内静脉导管相比差异无统计学意义(P=0.28,P=0.83)。结论为了降低ICU患者CRBSI的发生率,本研究建议在患者病情允许的前提下,将CVC导管的安置时间控制在7 d以内,否则应尽量选择锁骨下静脉作为置管部位,且在安置导管期间根据患者病情适当运用有抗菌效果的敷料及导管。而股静脉与颈内静脉置管的CRBSI发生风险是否有差异性还需要更多的研究来证明。

Objective A systematic review of the literature to determine the risk of catheter-related bloodstream infections and colonization in ICU patients with central venous catheters inserted at the femoral site as compared to subclavian and internal jugular placement.Methods Randomized controlled trials and observational ones were systematically retrieved,and meta-analysis was performed using RevMan Version 5.3.Results A total of 834 records were identified by the computerized searches,finally,eleven studies were meta-analyzed after screening.Results of Meta-analysis:the femoral site was associated with a significantly higher risk of catheter-related bloodstream infections and colonization compared to the subclavian vein site(P=0.0002,P<0.00001),but had no statistical difference compared with internal jugular site(P=0.28,P=0.83).Conclusion In order to reduce the incidence of CRBSI in ICU patients,this study suggested that the placement time of CVC catheter should be controlled within 7 days under the premise of patient condition,otherwise,the subclavian vein should be selected as the catheterization site as far as possible,and the antibacterial dressing and catheter should be used appropriately during the placement of catheter according to the patient's condition.Whether there is a difference in CRBSI risk between femoral vein and internal jugular vein site needs more studies to prove.