皮下隧道技术预防PICC置管后并发症效果的Meta分析

Effect of subcutaneous tunneling technique on preventing complications after PICC catheterization:a Meta-analysis

目的:系统评价皮下隧道技术对经外周静脉置入中心静脉导管(PICC)后并发症的预防效果。方法:检索PubMed、CINAHL、EMbase、the Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网和万方数据库关于皮下隧道技术预防PICC置管后并发症的随机对照试验(RCT),检索时限为建库至2023年6月。采用RevMan 5.4和Stata 14.0软件对纳入研究进行Meta分析。结果:最终共纳入15篇RCT。Meta分析结果显示,与常规置管技术相比,皮下隧道技术置管可有效降低导管脱出、置管24 h穿刺点渗血、穿刺点感染、导管堵塞、导管相关性血流感染、静脉炎、非计划性拔管的发生率及置管1周内维护次数(P<0.05)。两组静脉血栓发生率、一次置管成功率、一次穿刺成功率、置管时间、导管留置时间、操作时疼痛和操作时出血量比较,差异均无统计学意义(P>0.05)。结论:现有证据表明,皮下隧道技术可以降低PICC置管后并发症发生率,有效提高临床应用效果。

Objective:To systematically evaluate the preventive effect of subcutaneous tunnel technique on complications after PICC catheterization.Methods:RCTs on subcutaneous tunneling for the prevention of complications after PICC catheterization were retrieved from PubMed,CINAHL,EMbase,the Cochrane Library,Web of Science,CBM,CNKI and WanFang Database.The search period was up to June 2023.RevMan 5.4 and Stata 14.0 software were used for Meta-analysis integration of the included studies.Results:A total of 15 RCTs were included.The results of Meta-analysis showed that compared with conventional catheterization,subcutaneous tunnel catheterization could effectively reduce the incidence of catheter withdrawal,bleeding at the puncture site 24 h after catheterization,puncture site infection,catheter blockage,catheter-related bloodstream infection,phlebitis,unplanned extubation,and the number of maintenance within 1 week of catheterization(P<0.05).There were no significant differences in the incidence of venous thrombosis,the incidence of one successful catheterization,the incidence of one successful puncture,the time of catheterization,the time of catheter indentation,the pain during operation and the amount of blood loss between the two groups(P>0.05).Conclusion:The existing evidence shows that subcutaneous tunnel technique can reduce the incidence of complications after catheterization and effectively improve the clinical application effect.