摘要
目的系统评价经不同静脉和上肢置入PICC对穿刺置管成功率、并发症发生率的影响。方法计算机检索Cochrane图书馆、JBI循证护理中心图书馆、MEDLINE、EMbase、CBM、CNKI辅以互联网络检索。收集所有讨论PICC经不同静脉和上肢置入对穿刺置管成功率、并发症发生率影响的随机对照试验、半随机对照试验、病例对照研究、队列研究。由2名研究员按照纳入和排除标准筛选文献并提取资料,参考Cochrane Handbook及Newcastle-Ottawa Scale的质量评价标准进行质量评价,使用RevMan5.1软件进行Meta分析或仅进行描述性分析。结果共纳入4项半随机对照试验、14项队列研究,6 233例患者。Meta分析结果显示:PICC经头静脉穿刺的静脉炎发生率较贵要静脉高,合并效应有统计学意义[OR=0.12,95%CI(0.04,0.38),P=0.0002]。PICC经头静脉穿刺的送管困难发生率较贵要静脉高,合并效应有统计学意义[OR=0.26,95%CI(0.10,0.67),P=0.005]。经右侧上肢与左侧上肢穿刺的置管成功率与并发症发生率差异无统计学意义。结论经贵要静脉穿刺在降低并发症发生率方面具有优势,经不同上肢穿刺对穿刺置管成功率和并发症发生率的影响有待进一步证实,乳癌术后患侧置管应谨慎。
Objective To evaluate the influence of PICC placement through different veins and arms on catheterization success rate and complications. Methods Research papers which were about PICC placement through different veins and arms and discussed cathete- rization success rate and complications were searched in the Cochrane Library, JBI Library, MEDLINE, EMbase, CBM, CNKI and Internet sites, and these researches were limited to randomized controlled trails, quasi-randomized controlled trials, case-con- trol stu-dies, or cohort studies. Papers were screened according to the inclusion and exclusion criteria by two reviewers,and quality of enrolled papers was evaluated based on the Cochrane Handbook and Newcastle-Ottawa Scale. Meta-analysis was conducted by u- sing RevMan 5.1, or descriptive analysis was performed. Results Four quasi-randomized controlled trials and 14 cohort studies in- volving 6233 patients were included. The results of meta-analysis showed that PICCs inserted through the cephalic vein developed significantly higher incidence of phlebitis than through the basilic vein[OR = 0.12,95 %CI（0.04,0.38）, P= 0. 0002]. PICCs placed via the cephalic vein had more significant difficulty in advancing the catheters than via the basilic veins[OR = 0.26,95 % CI（O. 10, 0.67）, P= 0. 005]. No statistical differences were found isa catheterization success rate and incidence of complications when PICCs inserted in both arms. Conclusion PICC placement through basilic vein shows advantages in improving catheterization success rate and reducing complications. Influence of PICC placement through different arms on catheterization success rate and complications should be further studied. PICCs placed on the affected arm of breast cancer surgery should be very cautious.
基金
复旦大学护理学院科研基金项目(FNF201012)
关键词
PICC
静脉
上肢
乳癌
置管
并发症
系统评价
Meta分析
PICC
vein
arm
breast cancer
catheterization
complication
systematic review
meta-analysis
