新生儿上肢静脉与下肢静脉PICC置管效果比较的Meta分析

Effect of placement of peripherally inserted central catheter via the upper versus lower extremity veins: a Meta analysis

摘要:

目的 通过Meta分析方法比较新生儿经上肢静脉和经下肢静脉行经外周置入中心静脉导管（PICC）的置管效果。方法 检索中国知网、万方、维普中文科技期刊、中国生物医学文献以及PubMed、Web of Knowledge、EMBASE、Medline、Cochrane图书馆、Google Scholar等数据库中有关新生儿经上肢静脉行PICC与经下肢静脉行PICC置管效果比较的对照研究，采用RevMan 5.3软件对符合要求的研究进行Meta分析。结果 共纳入18项研究，其中8项为随机对照研究，10项为队列研究，包含研究对象4 890例。经下肢静脉行PICC组的并发症发生率（RR=0.83，95% CI：0.75~0.92，P < 0.05）、感染发生率（RR=0.77，95% CI：0.60~0.99，P < 0.05）、导管异位发生率（RR=0.28，95% CI：0.18~0.42，P < 0.05）、液体渗漏发生率（RR=0.52，95% CI：0.40~0.70，P < 0.05）、非计划性拔管率（RR=0.82，95% CI：0.69~0.98，P < 0.05）均低于经上肢静脉PICC组，一次穿刺成功率高于上肢静脉PICC组（RR=1.17，95% CI：1.05~1.30，P < 0.05），留置时间短于上肢静脉组（MD= -0.93，95% CI：-1.26~0.60，P < 0.05）。结论 目前证据表明，新生儿经下肢静脉行PICC优于上肢静脉。

Abstract:

Objective To investigate the effect of placement of peripherally inserted central catheter (PICC) via the upper versus lower extremity veins in neonates through a Meta analysis. Methods CNKI, Wanfang Data, VIP Data, CBMdisc, PubMed, Web of Knowledge, Embase, Medline, Cochrane Library and Google Scholar were searched for control studies on the effect of PICC placement via the upper versus lower extremity veins in neonates. RevMan 5.3 was used to perform a Meta analysis of the studies which met the inclusion criteria. Results A total of 18 studies were included, among which there were 8 randomized controlled trials and 10 cohort studies, with 4 890 subjects in total. Compared with those undergoing PICC placement via the upper extremity veins, the neonates undergoing PICC placement via the lower extremity veins had significantly lower incidence rates of complications (RR=0.83, 95%CI:0.75-0.92, P < 0.05), catheter-related infections (RR=0.77, 95%CI:0.60-0.99, P < 0.05), catheter malposition (RR=0.28, 95%CI:0.18-0.42, P < 0.05), extravasation of the infusate (RR=0.52, 95%CI:0.40-0.70, P < 0.05), and unplanned extubation (RR=0.82, 95%CI:0.69-0.98, P < 0.05). They also had a significantly higher first-attempt success rate of puncture (RR=1.17, 95%CI:1.05-1.30, P < 0.05) and a significantly shorter PICC indwelling time (MD=-0.93, 95%CI:-1.26-0.60, P < 0.05). Conclusions The above evidence shows that PICC placement via the lower extremity veins has a better effect than PICC placement via the upper extremity veins in neonates.