经外周静脉穿刺中心静脉置管治疗肿瘤患者血栓发生率的Meta分析

发布时间：2018-07-10 00:37

  本文选题：肿瘤 + 植入式静脉输液港　； 参考：《中国全科医学》2017年26期

【摘要】：目的通过Meta分析的方法探讨肿瘤患者应用植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)血栓发生风险的情况。方法计算机检索中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、Cochrane Library、PubMed、EMBase数据库中关于VAP(对照组)与PICC(PICC组)治疗肿瘤患者血栓发生率的随机对照试验、队列研究。检索时间从建库至2016年7月。进行资料提取及质量评价,采用Stata 12.0软件对数据进行Meta分析。结果共纳入4项随机对照试验、17项队列研究,共4 095例患者。Meta分析结果显示,PICC组血栓发生率高于对照组[RR=2.88,95%CI(1.92,4.33)]。根据PICC人员分为医生置管、护士参与置管、未报道3个亚组,Meta分析结果显示,当护士参与置管时,PICC组与对照组肿瘤患者血栓发生率比较,差异无统计学意义[RR=1.90,95%CI(0.93,3.89)]。医生置管、未报道两亚组,PICC组血栓发生率高于对照组[RR=3.06,95%CI(1.13,8.26);RR=3.83,95%CI(2.14,6.88)]。其他亚组分析显示,患者类型为住院患者、住院和出院患者,患者平均年龄≥18岁、18岁,PICC方式为未报道、盲穿或超声引导、超声引导,是否报道血栓诊断方法,研究类型为队列研究,不同发表国家PICC组血栓发生率均高于对照组。Begg秩相关法和Egger's直线回归法提示研究间无发表偏倚。结论与PICC比较,肿瘤患者采用VAP可以降低血栓的发生风险;由护士参与置管可以降低PICC血栓发生率;但是在临床应用中,肿瘤患者是否选择PICC还需要综合考虑其利弊。
[Abstract]:Objective to investigate the risk of thrombus in patients with tumor by means of meta-analysis with implanted venous infusion port (VAP) and central venous catheterization (PICC) via peripheral venous puncture. Methods A randomized controlled trial was conducted to search the database of China Biomedical document Service system (CBM), China knowledge Network (CNKI), Wanfang data knowledge Service platform and VIP Cochrane Library PubMedemBase database on the incidence of thrombus in patients with tumor treated by VAP (control group) and PICC (PICC group). Cohort study. The retrieval time was from the construction of the database to July 2016. The data were extracted and evaluated. Stata 12.0 software was used to analyze the data. Results A total of 17 cohort studies were conducted in 4 randomized controlled trials. The results of meta analysis showed that the incidence of thrombus in PICC group was higher than that in control group [RRN 2.88% 95 CI (1.92 卤4.33)]. The results of meta-analysis showed that there was no significant difference in the incidence of thrombus between the PICC group and the control group (RRR1.90 95 CI (0.93 卤3.89). The incidence of thrombus in PICC group was higher than that in control group. Other subgroup analysis showed that the patient types were inpatients, inpatients and discharged patients. The average age of the patients 鈮，

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