不同置管方式对PICC有效性及安全性影响的系统评价再评价

发布时间：2018-11-25 15:36

【摘要】：目的通过系统评价再评价探讨不同置管方式对PICC静脉输液技术安全性及有效性的影响,为护理人员临床决策提供参考。方法计算机检索Cochrane Library(2015年第10期)、Medline、Embase、中文期刊全文数据库、维普全文数据库、万方数据知识服务平台等数据库,检索时间从建库至2015年10月,检索不同置管方式对PICC静脉输液技术安全性及有效性影响的系统评价和Meta分析,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果最终纳入8篇系统评价/Meta分析,仅1篇为高质量,主要缺陷为缺乏前期设计方案、未考虑纳入文献的发表状态、未列出排除文献清单及未说明相关利益冲突4个方面。对5篇系统评价的15个结局指标按照GRADE系统进行证据质量评价,7个结局指标的证据质量为中,其余均为低。结论纳入系统评价/Meta分析的文献整体质量不高,结局指标的证据质量为中或低。总体上,超声引导/或结合改良赛丁格技术行PICC置管、并借助影像学标识可显著增加PICC的有效性及安全性,经不同静脉PICC置管的有效性无差异,但经贵要静脉穿刺可显著增加置管及维护的安全性。经不同上肢PICC置管的有效性和安全性无差异。受纳入研究的数量及质量限制,尚需更高质量的研究证实该结论的可靠性。
[Abstract]:Objective to explore the effect of different catheterization methods on the safety and effectiveness of PICC intravenous infusion through systematic evaluation and re-evaluation, and to provide reference for nursing staff in clinical decision-making. Methods Cochrane Library (No. 10, 2015), Medline,Embase, Chinese periodical full-text database, Weipu full-text database and Wanfang data knowledge service platform were searched by computer. The retrieval time was from the establishment of the database to October 2015. The systematic evaluation and Meta analysis of the effect of different catheterization methods on the safety and effectiveness of PICC intravenous infusion technique were searched. The methodological quality of the study was evaluated by AMSTAR tool and the outcome index was evaluated by GRADE system. Results 8 systematic reviews / Meta analyses were included, only one of them was of high quality. The main defects were the lack of early design scheme, the lack of the published status of the literature, the exclusion of the list of documents and the lack of explanation of the relevant conflicts of interest. According to the GRADE system, the results of 15 outcome indexes were evaluated according to GRADE system. The results showed that the evidence quality of 7 outcome indexes was low, while the others were low. Conclusion the overall quality of the literature included in the systematic evaluation / Meta analysis is not high, and the quality of the outcome indicators is medium or low. In general, ultrasound guided / combined with modified Sedinger technique for PICC catheterization can significantly increase the efficacy and safety of PICC, but there is no difference in the effectiveness of PICC catheterization via different veins. However, the safety of catheterization and maintenance can be significantly increased by puncture via your vein. There was no difference in the efficacy and safety of PICC tube placement with different upper limbs. Higher-quality studies are needed to confirm the reliability of this conclusion, given the quantitative and qualitative limitations of the included studies.
【作者单位】：复旦大学护理学院;复旦大学附属肿瘤医院;复旦大学公共卫生学院;复旦大学附属儿科医院;
【基金】：卫生部卫生技术评估重点实验室(复旦大学)开放基金课题
【分类号】：R472.9

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