重症患者血管导管相关感染危险因素的Meta分析

Risk factors of Vessel Catheter-Associated Infection in critical patients:a Meta-analysis

目的:系统评价重症患者血管导管相关感染的危险因素。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中关于重症患者血管导管相关感染危险因素的文献。采用Stata 12.0软件进行Meta分析。结果:共纳入20篇文献,总样本量为17539例,血管导管相关感染发生率为0.72%~33.33%。Meta分析显示,年龄较大、APACHE II评分较高、合并糖尿病、合并基础疾病、免疫功能降低、血清白蛋白水平过低、置管者工作经验不足、反复穿刺、置管部位为股静脉、管腔数目>1个、ICU住院时间较长、大量使用抗生素、静脉输注营养液、置管时间较长是重症患者发生血管导管相关感染的危险因素。结论:基于现有证据,置管前建议评估患者疾病严重程度、并发症、免疫功能等情况,规范置管流程,合理选择置管部位及管腔数目,置管后注意导管维护,尽量缩短置管时间,以减少重症患者血管导管相关感染的发生。

Objective:To systematically evaluate the risk factors of Vessel Catheter-Associated Infection(VCAI)in critical patients.Methods:The studies on risk factors of VCAI in critical patients were searched and enrolled from databases including PubMed,Web of Science,Cochrane Library,Embase,CNKI,WanFang data,VIP and CBM to do Meta-analysis using Stata 12.0.Results:A total of 20 studies with a total sample size of 17539 were recruited of which the incidence of VCAI ranged from 0.72%to 33.33%.Meta-analysis showed that older age,high APACHE II score,diabetes mellitus,basic diseases,decreased immune function,lower serum albumin level,medical staff's lacking experience in cannulation,repeated venipuncture,femoral vein catheterization,lumen number>1,longer stay in ICU,heavy use of antibiotics,intravenous infusion of nutrient solution,longer indwelling time were risk factors for VCAI in critical patients.Conclusion:Based on the above evidence,it is recommended to have an overall assessment of the patients before catheterization such as severity of disease,complications,immune function and so on,standardize the catheterization process,rationally select the catheterization site and lumen number,pay attention to catheter maintenance after catheterization,and minimize the indwelling time to reduce the occurrence of VCAI in critical patients.