国内长期留置导尿管患者硅胶导尿管更换时间的Meta分析

摘要

目的：探讨长期留置导尿管患者更换硅胶导尿管的最佳时间。方法检索国内相关文献，采用Cochrane系统评价方法对符合纳入、排除标准的随机对照试验进行Meta分析。研究对象为已发表的有关长期留置导尿管患者硅胶导尿管更换时间研究的临床对照试验，观察指标为留置导尿管患者硅胶导尿管不同更换频率（每2周更换、每3周更换及每4周更换1次）下的泌尿系感染率。干预有效性的效应量采用相对危险度（relative risk，RR）。结果共检索到11篇合格文献。Meta分析结果提示：长期留置导尿管患者硅胶导尿管每2周更换1次与每4周更换1次、每3周更换1次与每4周更换1次发生泌尿系感染的RR值分别为0.51[95% CI（0.40，0.66），P<0.001]、0.79[95% CI（0.58，1.08），P=0.14]，每2周更换1次者泌尿系感染率明显高于每4周更换1次者，但每3周更换1次者与每4周更换1次者泌尿系感染率没有差异。结论结合硅胶导尿管的材料性质及其观察指标，根据临床最优原则，得出硅胶导尿管每4周更换1次为宜。%ObjectiveTo explore the best time for replacing the long-term indwelling catheter in patients with silicone catheter.MethodsDomestic literature were retrieved and analyzed using Cochrane systematic review,and the meta-analysis of randomized controlled trials was conducted in accordance with inclusion criteria and exclusion criteria so as to look into the most suitable time for replacing the indwelling catheter for patients with silicone catheter at clinical trials.The replacement frequency for the catheters of different size together with the relevant infections in urinary tract infection and relative risk(RR)were used as values for effectiveness of interventions.ResultsA total of 11 literature were retrieved. Meta-analysis results suggested that the RR values of urinary tract infections when the catheters were replaced once every two weeks vs. every four weeks,and once every three weeks vs. every four weeks were 0.51[95% CI(0.40,0.66),P <0.001],0.79[95% CI(0.58,1.08),P = 0.14],respectively.The urinary infection rate of replacing a silicone cathether every 2 weeks was higher than that of every 4 weeks,but there was no difference between that of every 3 weeks and 4 weeks.Conclusion According to the nature of silicone catheter material as well as the clinical indexes, it is most reliable to replace a silicone catheter every four weeks to reach a best clinical outcome.