两种不同针尖斜面穿刺动静脉内瘘方法对维持性血液透析患者影响的Meta分析

Meta-analysis of the effects of two puncture methods with different needle slope for internal arteriovenous fistulas on maintenance hemodialysis patients

目的系统分析针尖斜面向下和针尖斜面向上穿刺动静脉内瘘对维持性血液透析(MHD)患者的影响。方法通过计算机检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库等中英文数据库,收集采用斜面向上和斜面向下穿刺内瘘的相关研究。根据文献纳入标准与排除标准筛选文献后,提取相关数据并进行文献质量评价,采用RevMan 5.4软件进行Meta分析。结果最终纳入12篇文献,共748例患者。Meta分析结果显示:斜面向下穿刺组内瘘血管瘤发生率、内瘘狭窄发生率、内瘘闭塞发生率、疼痛发生率均低于斜面向上穿刺组(均P<0.05),而两种斜面穿刺方法的内瘘一次穿刺成功率差异无统计学意义(P>0.05)。结论对于MHD患者,采用针尖斜面向下穿刺内瘘,有利于减少血管损伤,降低内瘘血管瘤、内瘘狭窄和内瘘闭塞的发生率,减轻患者内瘘穿刺的疼痛,且不影响内瘘穿刺成功率,值得临床推广使用。

Objective To systematically analyze the effects of puncture methods with needle beveled downward and upward on internal arteriovenous fistulas in maintenance hemodialysis(MHD)patients.Methods Through computer retrieval of PubMed,Web of Science,Embase,Cochrane Library,China National Knowledge Infrastructure,Wan Fang Database,VIP Database,Chinese Biomedical Literature Database and other Chinese and English databases,relevant studies on punctures of internal fistula with needle beveled downward and upward were collected.After screening the literature according to the literature inclusion and exclusion criteria,relevant data were extracted and literature quality evaluation was performed,RevMan 5.4 software was used for Meta-analysis.Results A total of 12 studies involving 748 patients were included in the end.The results of the Meta-analysis showed that the incidences of internal fistula hemangioma,internal fistula stenosis,internal fistula occlusion,and pain of internal fistula in the beveling downward puncture group were lower than those in the beveling upward puncture group(all P<0.05),while there was no significant difference in the success rate of internal fistula at first attempt between the two beveling puncture methods(P>0.05).Conclusion For MHD patients,the application of needle beveled downward puncture of the internal fistula is conducive to reducing vascular injury and the incidences of internal fistula hemangioma,internal fistula stenosis and internal fistula occlusion,relieving the pain of internal fistula puncture,and does not affect the success rate of internal fistula puncture,which is worthy of clinical promotion.