ICU患者中心静脉导管血流感染危险因素的Meta分析

摘要

目的 通过 Meta 分析明确重症监护病房(ICU)患者中心静脉导管血流感染(CRBSI)的危险因素.方法 计算机检索The Cochrane Library、PubMed、Embase、CBM、CNKI、WanFang Data 数据库中关于 ICU 患者CRBSI危险因素的研究文献,应用RevMan 5.3软件对纳入文献进行 Meta 分析.结果 符合纳入标准的文献有12篇,总样本量为14422例,5篇队列研究,7篇病例对照研究,NOS评分为4~6分.Meta分析结果显示:导管留置时间(WMD=12.25,95%CI=5.55~18.94)、多腔导管(OR=3.52,95% CI=1.46~8.52)、股静脉置管(OR=2.44,95%CI=1.34~4.46)、肠外营养(OR=2.47,95% CI=1.18~5.21)、住ICU 的时间(WMD=10.01,95% CI=4.17~15.85)、APACHEⅡ评分(WMD=4.46,95%CI=1.25~7.66)、合并糖尿病(O R=1.83,95%CI=1.08~3.09),各组差异有统计学意义(均P<0.05).结论 导管留置时间、多腔导管、股静脉置管、肠外营养、住ICU 的时间、APACHEⅡ评分、合并糖尿病是ICU 患者CRBSI危险因素.因纳入研究总体方法学质量一般,尚需设计严谨、大样本的前瞻性队列研究对结果进行进一步验证.%Objective To evaluate risk factors for central venous catheter-related bloodstream infection(CRBSI)in intensive care unit(ICU)patients by Meta analysis. Methods Literatures about risk factors of CRBSI in ICU pa-tients were retrieved from databases of Cochrane Library,PubMed,Embase,CBM,CNKI,and WanFang Data,RevMan 5.3 software was used for Meta analysis.Results There are 12 literatures in accordance with the inclusion criteria,with a total sample size of 14 422 cases,5 cohort studies and 7 case-control studies,the Newcastle-Ottawa Scale(NOS)scores were 4-6 points. According to Meta analysis,duration of indwelling catheter(WMD,12.25 [95%CI,5.55-18.94]),multi-cavity catheter(OR,3.52[95% CI,1.46-8.52]),femoral vein catheterization (OR,2.44[95%CI,1.34-4.46]),parenteral nutrition(O R,2.47[95% CI,1.18-5.21]),length of stay in ICU(WMD,10.01[95%CI,4.17-15.85]),APACHE II score(WMD,4.46[95%CI,1.25-7.66]),and dia-betes mellitus(OR,1.83[95% CI,1.08-3.09])were significantly different in each group(all P<0.05). Conclusion Risk factors for CRBSI in ICU patients are duration of indwelling catheter,multi-cavity catheter,femo-ral vein catheterization,parenteral nutrition,length of stay in ICU,APACHE II score,and diabetes mellitus. However,due to the limitation of methodological quality of included studies,more strictly designed and large sam-ple prospective studies are needed to verify the result.