置入中长导管与PICC并发症发生率比较的Meta分析

Meta-analysis of the incidence rates of common complications between insertion of midline catheters and PICC

目的:Meta分析置入中长导管与经外周静脉穿刺中心静脉导管(PICC)常见并发症,比较中长导管和PICC的安全性。方法:检索中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane library数据库中关于患者置入中长导管与PICC并发症发生率比较的随机对照试验,并通过RevMan 5.4软件进行Meta分析。结果:纳入19篇文献,共1798例研究对象。Meta分析结果显示,中长导管静脉血栓发生率(RR=0.21,95%CI 0.10~0.44)、导管相关血流感染发生率(RR=0.19,95%CI 0.08~0.42)与PICC相比,差异均有统计学意义(均P<0.0001);静脉炎发生率(RR=0.85,95%CI 0.53~1.36)、导管外渗发生率(RR=0.85,95%CI 0.46~1.57)、导管移位发生率(RR=0.74,95%CI 0.41~1.34)、导管堵塞发生率(RR=0.93,95%CI 0.58~1.50)、导管脱出发生率(RR=0.90,95%CI 0.35~2.31)与PICC相比,差异均无统计学意义(均P>0.05)。在中长导管≥20 cm亚组中,中长导管静脉血栓发生率(RR=0.20,95%CI 0.08~0.49)、导管相关血流感染发生率(RR=0.16,95%CI 0.06~0.44)与PICC相比,差异均有统计学意义(均P<0.05)。结论:中长导管静脉血栓、导管相关血流感染发生率低于PICC,亚组分析中长导管长度≥20 cm的静脉血栓、导管相关血流感染发生率同样低于PICC,但使用中长导管不能降低静脉炎、导管外渗、导管移位、导管堵塞、导管脱出发生率。

Objective:To perform a meta-analysis comparing the common complications of insertion of midline catheter and peripherally inserted central venous catheter(PICC),and to evaluate the safety of midline catheter and PICC.Methods:Retrieve data from China National Knowledge Infrastructure(CNKI),Wanfang Date,VIP database,Chinese Biology Medicine(CBM),PubMed,Embase and Cochrane Library.Comparison of randomized controlled trials and Meta-analysis were conducted using RevMan 5.4 software.Results:Data from 19 papers,totaling 1,798 subjects,were included.The Meta-analysis showed that the incidences of venous thrombosis(RR=0.21,95%CI 0.10-0.44)and catheter-related bloodstream infection(RR=0.19,95%CI 0.08-0.42)for insertion of midline catheters were statistically significant(both P<0.0001).There were no significant differences in the incidence of phlebitis(RR=0.85,95%CI 0.53-1.36),catheter extravasation(RR=0.85,95%CI 0.46-1.57),catheter migration(RR=0.74,95%CI 0.41~1.34),catheter occlusion(RR=0.93,95%CI 0.58~1.50),or catheter dislodgement(RR=0.90,95%CI 0.35-2.31)compared with PICC(P>0.05).Among the midline catheter≥20 cm subgroup,the incidence of venous thrombosis(RR=0.20,95%CI 0.08-0.49)and catheter-related bloodstream infection(RR=0.16,95%CI 0.06-0.44),both were statistically significant(both P<0.05).Conclusion:The incidence of venous thrombosis and catheter-related bloodstream infection in midline catheters is lower than that in PICC.In the subgroup analysis of midine catheters with a length of≥20 cm,the incidence of venous thrombosis and catheter-related bloodstream infection is also lower than that in PICC.However,the use of midline catheters cannot reduce the incidence of phlebitis,catheter extravasation,catheter migration,catheter occlusion,and catheter dislodgement.