静脉留置针采血对血液标本影响的Meta分析

摘要

目的 通过Meta分析,系统评价从外周静脉留置针采血对血液标本的影响.方法 系统检索Cochrane Library、PubMed、EBSCO、CINAHL、Embase和中国生物医学文献数据库、中国知网、万方和维普数据库中留置针采血对血液标本影响的随机对照试验,由2名研究人员独立筛选文献并提取资料,对符合质量标准的随机对照试验进行Meta分析.结果 共纳入22篇文献,包括7 554例研究对象.与一次性采血针采血相比,通过留置针采血不会提高血液标本的溶血率[RR=2.01,95％CI(1.01,4.00),P=0.05];采取一定方法后,从封管或输液中的留置针采集的血液标本对红细胞计数、白细胞计数、血小板计数、空腹血糖、血清钠、血清钾、血清钙、血清氯浓度的检验结果的影响较小,差异无统计学意义(P＞0.05).结论 通过普通留置针、封管中的留置针弃去2～5 ml血液、输液中的留置针暂停输液2～3 min并弃去2～5 ml血液后采血,不会提高血液标本的溶血率,可以得到可靠的血常规和生化常规血液标本.综合考虑,静脉采血时可交替使用静脉留置针与一次性采血针.%Objective To evaluate the effects of blood withdrawal from peripheral intravenous catheters (PIC) on blood samples via meta-analysis.Methods We performed a systematic search in Cochrane Library,PubMed,EBSCO,CINAHL,Embase,CMBdisc (China Biology Medicine disc),Wan Fang Data,VIP (China Science and Technology Journal Database),CNKI (China National Knowledge Infrastructure)to collect randomized controlled trails (RCTs)about the effects of blood withdrawal from peripheral intravenous catheters.The quality of RCTs was critically appraised and data were extracted by two reviewers independently.Meta-analysis was conducted for eligible RCTs.Results Totally 22 studies were retrieved and 7554 blood samples were included.Results of meta-analysis showed as compared with standard blood drawn by direct venipuncture (DVP),there was no significant risk of hemolysis rates of blood samples collected from PVC [random effect RR =2.01,95％ CI (1.01,4.00),P=0.05];with certain procedures,results of laboratory tests of blood samples withdrawal from PIC had little impacts on red blood cell count(RBC),white blood cell count(WBC),platelet count (PLT),fasting blood-glucose(FBG)and serum levels of sodium,potassium,calcium,chlorine,and the differences had no statistical significance (P＞0.05).Conclusion Blood samples withdrawal from PIC will not increase hemolysis if sampling after infusion has been stopped for 2～3 min and 2～5 ml blood is discharged,which are reliable for blood routine and biochemical tests.After a comprehensive consideration,the technique of blood withdrawal from a PIC could be used interchangeably from DVP.