经外周静脉穿刺中心静脉置管与其他中心静脉置管相关性静脉血栓的meta分析

摘要

ABSTRACT:Objective To systematically compare the risk of peripherally inserted central catheters(PICCs)and centralvenous catheters(CVCs)related vein thrombosis.Methods The PubMed,the Cochrane Library,CNKI,CBM and Wan fang databases were searched to find literatures evaluating PICCs and CVCs related vein thrombosis.Results A total of 17 studies with 6 299 participants were finally included in the meta-analysis.The pooled odd risk for PICCs related vein thrombosis was 2.785(95%CI =1.796-4.321,P <0.01).The pooled odd risk for malignant tumor and intensive care were 3.049 (95%CI =1.949-4.770,P <0.01)and 3.954(95%CI =2.181-7.168,P <0.01),respectively.NNT=-30,95%CI =-31.25 -27.78.There were no publication bias,and the outcome was stable by the sensitivity analysis.Conclusion PICCs increased the morbidity of vein thrombosis,especially for malignant tumor and intensive care,so PICCs related vein thrombosis needs more attention in clinic.%目的：通过系统分析比较经外周静脉穿刺中心静脉置管(peripherally inserted central catheters,PICCs)和其他中心静脉置管(centralvenous catheters,CVCs)相关性静脉血栓发生风险。方法检索 PubMed 数据库、Cochrane临床试验数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方数据库,查找 PICCs 和 CVCs相关静脉血栓发生风险的临床对照研究。结果依纳入标准,共包含17个研究,6299例患者。Meta分析结果显示：与CVCs相比,PICCs置管静脉血栓发生风险升高(OR =2.785,95%CI =1.796~4.321,P<0.01),亚组分析提示恶性肿瘤和重症监护患者静脉血栓发生风险均明显升高(恶性肿瘤：OR =3.049,95%CI =1.949~4.770,P <0.01；重症监护：OR=3.954,95%CI =2.181~7.168,P<0.01)。需治疗人数(NNT)=-30,95%CI =-31.25~-27.78。漏斗图及 Egg检验未见明显发表偏倚,敏感性分析显示结果稳定。结论 PICCs高于CVCs相关性静脉血栓的发生风险,尤其对恶性肿瘤和重症监护患者,临床应加强PICCs使用者的血栓筛查。