癌症患者中心静脉导管相关性血栓现状及危险因素meta分析

Status and risk factors of central venous catheter-related thrombosis in cancer patients:A meta-analysis

目的分析癌症患者中心静脉导管相关性血栓的现状及危险因素。方法检索PubMed、Web of Science、Cochrane Library、CNKI、万方、CBM和EBSCO等数据库中有关癌症患者中心静脉导管相关性血栓独立危险因素的相关文章,检索时间从建库至2022年5月,合并结局指标,Meta分析使用RevMan5.3软件。结果17篇文献纳入,共10628例患者,导管相关性血栓的人数为832例,感染发生率为7.82%,危险因素有10项。分析独立危险因素的OR值及95%CI,年龄>60岁(OR=2.73,95%CI为2.62~2.84)、二次调整导管位置(OR=2.93,95%CI为1.94~4.41)、导管类型(OR=2.08,95%CI为1.58~2.73)、导管异位(OR=2.64,95%CI为2.00~3.48)、D-二聚体水平(OR=1.18,95%CI为1.10~1.27)、肿瘤分期(tumor mode metastasis,TNM分期)为晚期(OR=3.07,95%CI为2.25~4.18)、化疗(OR=2.40,95%CI为1.59~3.62)、肿瘤部位(OR=3.14,95%CI为2.09~4.74)、患者合并糖尿病(OR=2.60,95%CI为1.65~4.09)、既往有导管相关性血栓病史(OR=4.03,95%CI为1.69~9.61),各组差异均有统计学意义(均P<0.05)。结论年龄>60岁、二次调整导管位置、导管类型、导管异位、D-二聚体水平较高、TNM分期为晚期、化疗、肿瘤部位、既往有导管相关性血栓病史、合并糖尿病是癌症患者发生中心静脉导管相关性血栓的独立危险因素。临床上重视高危人群和相关危险因素,采取有效的干预措施,降低中心导管相关性血栓的发生。

Objective To analyze the status and risk factors of central venous catheter-related thrombosis in cancer patients.Methods The related articles on independent risk factors for central venous catheter-related thrombosis in cancer patients were searched in PubMed,Web of Science,Cochrane Library,CNKI,Wanfang,CBM,EBSCO and other databases,which were retrieved from database establishment to May 2022.The outcome measures were combined and meta-analysis was performed using RevMan5.3 software.Results A total of 10628 patients were included in 17 literatures,including 832 cases of catheter-related thrombosis,the infection rate was 7.82%and there were 10 risk factors.The OR value and 95%CI of independent risk factors were analyzed:age>60 years old(OR=2.73,95%CI:2.62-2.84),secondary adjustment of catheter position(OR=2.93,95%CI:1.94-4.41),catheter type(OR=2.08,95%CI:1.58-2.73),ectopic catheter(OR=2.64,95%CI:2.00-3.48),D-dimer level(OR=1.18,95%CI:1.10-1.27),tumor mode metastasis(TNM)was late stage(OR=3.07,95%CI:2.25-4.18),chemotherapy(OR=2.40,95%CI:1.59-3.62),tumor site(OR=3.14,95%CI:2.09-4.74),combined diabetes(OR=2.60,95%CI:1.65-4.09),previous history of catheterrelated thrombosis(OR=4.03,95%CI:1.69-9.61),and the difference was statistically significant among all groups(P<0.05).Conclusions Age>60 years old,secondary catheter position adjustment,catheter type,catheter ectopic,higher D-dimer level,advanced TNM stage,chemotherapy,tumor site,previous history of catheter-related thrombosis,and combined diabetes are independent risk factors forcentral venous catheter-related thrombosis in cancer patients.Clinically,attention should be paid to high-risk groups and related risk factors,and effective intervention measures should be taken to reduce the occurrence of central catheter-related thrombosis.