经不同上肢置入 PICC 对置管结局影响的 Meta 分析

Meta-analysis the effects of PICC placement by different upper limbs on catheterization outcomes

目的评价经不同上肢置入PICC对置管结局的影响。方法检索Cochrane Library、PubMed、Embase、Web of Science、OVID Medline、中国知网、万方医学网、维普中文科技期刊数据库中有关经不同上肢置入PICC对置管结局影响的随机对照试验、类实验研究或队列研究,检索时限为建库至2023年12月11日。结果共纳入21篇文献,包括3篇随机对照研究,2篇类实验研究,16篇队列研究。经左侧肢体置入PICC的患者5288例,右侧7681例。Meta分析结果显示,与右侧肢体相比,经左侧肢体置入PICC置管障碍发生率高[RR=1.15,95%CI(1.01,1.32),P<0.01];但两组导管的一次性穿刺成功率、导管脱出、导管堵塞、导管相关的血流感染、导管异位、静脉炎和静脉血栓(上肢肿胀)的发生率比较,差异无统计学意义。结论经不同上肢置入PICC对置管结局的影响差别不是很明显,PICC置管部位的选择应充分尊重患者意愿,可优先选择左侧肢体。

Objective To evaluate the impact of PICC inserted through different upper limbs on the catheterization outcomes.Methods Databases including the Cochrane Library,PubMed,Embase,Web of Science,OVID Medline,China National Knowledge Infrastructure(CNKI),Wanfang Medical Network and VIP Chinese Science and Technology Journal Database were searched for randomized controlled trials,quasi-experimental studies or cohort studies regarding the impact of PICC inserted through different upper limbs on the catheterization outcomes.The search period was from database establishment to December 11,2023.Results A total of 21 articles were included in this study,including 3 randomized controlled ctudies,2 quasi experimental studies,and 16 cohort study.There were 5288 patients through left limb PICC implantation and 7681 patients through right limb.The result of Meta-analysis showed that compared with the right limb,the incidence of PICC catheterization obstacle through the left limb is higher[RR=1.15,95%CI(1.01,1.32),P<0.01].However,there was no significant increase in the one-time success rate of PICC in the left limb,the incidence of catheter prolapses,catheter blockage,catheter-associated bloodstream infection,catheter misplacement,phlebitis,and venous thrombosis(upper limb swelling).Conclusion There is no significant difference in the effect of PICC placement in different upper limbs on the catheterization outcome.The choice of PICC placement site should fully respect the wishes of patients,and the left limb can be preferred.