住院患儿静脉置管有效性及安全性影响因素的系统评价再评价

Systematic evaluation and re-evaluation of influencing factors on the effectiveness and safety of venous catheterization in hospitalized children

目的:通过系统评价再评价探讨儿童静脉置管有效性及安全性的影响因素,为临床护理工作者提供参考。方法:计算机结合人工检索中国知网、万方数据库、维普数据库和中国生物医学文献数据库、Web of Science、PubMed、MedLine、EBSCO、the Cochrane Library有关住院患儿静脉置管的系统评价及Meta分析文献,检索时限为2011年1月—2022年10月,采用系统评价的质量评价工具(AMSTAR)评价纳入研究的方法学质量,应用系统评价和Meta分析的报告规范(PRISMA)评价纳入研究报告质量,采用推荐分级、评估、制定和评价(GRADE)证据分级对结局指标进行评价。结果:最终纳入14篇系统评价/Meta分析,整体报告质量平均分23.6分,质量较高;GRADE证据等级评价为高质量文献1篇,中等质量文献7篇,低质量文献5篇,极低质量2篇;Kappa一致性值为0.903。Meta分析结果显示,导管相关性血流感染[OR=0.189,95%CI(0.034,0.343),Z=2.40,P=0.017]、死亡率[OR=0.440,95%CI(0.053,0.827),Z=2.23,P=0.026]差异有统计学意义,定性分析结果显示新生儿PICC相关感染危险因素包括胎盘早剥、体质量≤1500 g、胎龄≤37周、呼吸窘迫、Apgar≤7分、堵管史、病房置管,保护因素包括穿刺时长≤30 min、穿刺次数<2次、导管留置时间≤7 min。结论:纳入系统评价/Meta整体质量中等,报告质量为高质量,结局指标的证据质量为中或低级。胎盘早剥、体质量≤1500 g、胎龄≤37周、呼吸窘迫、Apgar≤7分、堵管史、病房置管是新生儿PICC相关感染危险因素,穿刺时长≤30 min、穿刺次数<2次、导管留置时间≤7 min是新生儿PICC相关感染的保护因素。

Objective:To explore the influencing factors of the effectiveness and safety of intravenous catheterization in children through systematic evaluation and re-evaluation,and provide references for clinical nursing workers.Methods:Systematic review and Meta analysis of literature on venous catheterization in hospitalized children was conducted on CNKI,WanFang Database,VIP Database,CBM,Web of Science,PubMed,MedLine,EBSCO,the Cochrane Library.The retrieval time was from January 2011 to October 2022.AMSTAR tool was used to evaluate the methodological quality of the included study,PRISMA tool was used to evaluate the quality of the included study report,and GRADE evidence grading was used to evaluate the outcome indicators.Results:14 systematic evaluations/Meta-analysis were ultimately included,with an average overall report quality score of 23.6 points,indicating high quality;the GRADE evidence level evaluation includes 1 high-quality literature,7 medium quality literature,5 low quality literature,and 2 extremely low quality literature;the Kappa consistency value was 0.903.The Meta-analysis results showed that catheter associated bloodstream infection(OR=0.189,95%CI 0.034-0.343,Z=2.40,P=0.017);the mortality rate(OR=0.440,95%CI 0.053-0.827,Z=2.23,P=0.026)showed statistically significant differences.Qualitative analysis results showed that risk factors for neonatal PICC infection included placental abruption,body mass≤1500 g,gestational age≤37 weeks,respiratory distress,Apgar≤7 points,history of catheter occlusion,and ward catheterization;the protective factors for neonatal PICC related infections include puncture duration≤30 minutes,puncture frequency<2 times,and catheter retention time≤7 minutes.Conclusion:The overall quality of inclusion in the system evaluation/Meta-analysis is of medium quality,the quality of reporting is of high quality,and the quality of evidence for outcome indicators is of medium or low quality.Placental abruption,body mass≤1500 g,gestational age≤37 weeks,respiratory distress,Apgar≤7 points,history of catheter occlusion,and ward catheterization are risk factors for neonatal PICC related infections;the protective factors for neonatal PICC related infections are puncture duration≤30 minutes,puncture frequency<2 times,and catheter retention time≤7 minutes.