肿瘤患者PICC与CVC效果及安全性的系统评价
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摘要
目的通过对国内已发表的有关肿瘤患者经外周中心静脉置管(PICC)与中心静脉置管(CVC)临床应用随机对照实验文献进行系统评价,进一步分析比较这两种置管方法在肿瘤患者临床应用中的效果及安全性。方法计算机检索中国知网(CNKI)、万方和维普等数据库关于肿瘤患者PICC及CVC两种置管临床应用随机对照研究的文献,检索时间均从建库到2018年8月。由两位研究者根据纳入与排除标准独立筛选文献、提取数据资料和评价纳入研究的方法学质量后,采用MATLAB-R2016软件进行Meta分析。结果共检索436篇文献,最终纳入文献19篇,共纳入2 242例肿瘤患者。Meta分析结果显示,PICC组一次置管成功率显著高于CVC组[RR=1.16,95%CI(1.03～1.31),P=0.018]; PICC组置管留置时间显著大于CVC组[MD=87.98,95%CI(54.64～121.33),P<0.01]; PICC组导管脱落率显著低于CVC组[RR=0.21,95%CI(0.12～0.37),P<0.01]; PICC组导管感染率显著低于CVC组[RR=0.23,95%CI(0.15～0.37),P<0.01]; PICC组气胸发生率显著低于CVC组[RR=0.16,95%CI(0.06～0.46),P<0.01]; PICC组误入动脉的发生率显著低于CVC组[RR=0.17,95%CI(0.08～0.36),P=0.001];而PICC组静脉炎发生率显著高于CVC组[RR=3.53,95%CI(2.15～5.81),P<0.01];此外两组导管阻塞发生率无统计学意义(P>0.05)。结论 PICC在肿瘤患者临床应用中具有一次置管成功率高、置管留置时间长、并发症少等特点,可更好、广泛地应用于临床肿瘤患者中。
Objective To compare the efficacy and safety of peripherally inserted central catheter( PICC) and central venous catheter( CVC) in the clinical application of cancer patients by systematic evaluation of all published clinically relevant randomized controlled trials of those two catheterization methods.Methods The literature of randomized controlled clinical trials of PICC and CVC in cancer patients were retrieved from CNKI,Wan Fang Data and VIP databases. The retrieval time was from the establishment of the database to August 2018. Meta-analysis was performed using MATLAB-R2016 software after two researchers independently screened the literature,extracted data and evaluated the methodological quality of the included studies according to the inclusion and exclusion criteria. Results A total of 436 articles were retrieved,and 19 articles were eventually included,involving 2 242 patients with cancer. Meta-analysis showed that the success rate of primary catheterization in the PICC group was significantly higher than that in the CVC group [RR =1.16,95% CI( 1.03-1.31),P = 0.018]; the indwelling time in the PICC group was significantly longer than that in the CVC group [MD = 87.98,95% CI( 54.64-121.33),P< 0.01]; the catheter shedding rate in the PICC group was significantly lower than that in the CVC group [RR = 0.21,95% CI( 0.12-0.37),P<0.01].The catheter infection rate in the PICC group was significantly lower than that in the CVC group [RR = 0.23,95% CI( 0.15-0.37),P<0.01]; the incidence of pneumothorax in the PICC group was significantly lower than that in the CVC group [RR = 0. 16,95% CI( 0. 06-0. 46),P < 0. 01]; the incidence of mistakenly entering arteries in the PICC group was significantly lower than that in the CVC group [RR = 0. 17,95% CI( 0. 08-0.36),P = 0.001]; and the incidence of phlebitis in the PICC group was significantly higher than that in the CVC group [RR = 3.53,95% CI( 2.15-5.81),P< 0.01]. In addition,there was no significant difference in the incidence of catheter obstruction between the two groups( P > 0. 05). Conclusion PICC has the characteristics of high success rate,long indwelling time and fewer complications in the clinical application of cancer patients,which can be widely used in clinical cancer patients. And the quality of all the research papers included in this study is low,the evaluation of the efficacy and safety of PICC and CVC needs to continue to increase the level of research forfurther validation analysis.
Objective To compare the efficacy and safety of peripherally inserted central catheter( PICC) and central venous catheter( CVC) in the clinical application of cancer patients by systematic evaluation of all published clinically relevant randomized controlled trials of those two catheterization methods.Methods The literature of randomized controlled clinical trials of PICC and CVC in cancer patients were retrieved from CNKI,Wan Fang Data and VIP databases. The retrieval time was from the establishment of the database to August 2018. Meta-analysis was performed using MATLAB-R2016 software after two researchers independently screened the literature,extracted data and evaluated the methodological quality of the included studies according to the inclusion and exclusion criteria. Results A total of 436 articles were retrieved,and 19 articles were eventually included,involving 2 242 patients with cancer. Meta-analysis showed that the success rate of primary catheterization in the PICC group was significantly higher than that in the CVC group [RR =1.16,95% CI( 1.03-1.31),P = 0.018]; the indwelling time in the PICC group was significantly longer than that in the CVC group [MD = 87.98,95% CI( 54.64-121.33),P< 0.01]; the catheter shedding rate in the PICC group was significantly lower than that in the CVC group [RR = 0.21,95% CI( 0.12-0.37),P<0.01].The catheter infection rate in the PICC group was significantly lower than that in the CVC group [RR = 0.23,95% CI( 0.15-0.37),P<0.01]; the incidence of pneumothorax in the PICC group was significantly lower than that in the CVC group [RR = 0. 16,95% CI( 0. 06-0. 46),P < 0. 01]; the incidence of mistakenly entering arteries in the PICC group was significantly lower than that in the CVC group [RR = 0. 17,95% CI( 0. 08-0.36),P = 0.001]; and the incidence of phlebitis in the PICC group was significantly higher than that in the CVC group [RR = 3.53,95% CI( 2.15-5.81),P< 0.01]. In addition,there was no significant difference in the incidence of catheter obstruction between the two groups( P > 0. 05). Conclusion PICC has the characteristics of high success rate,long indwelling time and fewer complications in the clinical application of cancer patients,which can be widely used in clinical cancer patients. And the quality of all the research papers included in this study is low,the evaluation of the efficacy and safety of PICC and CVC needs to continue to increase the level of research forfurther validation analysis.
引文
1李美萍,陈建明,李莲.PICC置管在肿瘤化疗患者中的应用研究[J].国际护理学杂志,2010,29(1):57-59.
2戴晓军,徐亮,高晓琴,等.中心静脉置管在中医肿瘤科的临床应用及价值[J].中国当代医药,2014,21(36):18-21.
3 Higgins JPT,Green S.Cochrane Handbook for Systematica Reviews for Interventions 5.1.2[updated March 2011][EB/OL].http://www.cochrane.org/resources/handbook/hbook.thm(accessed2011).
4刘鸣.系统评价、Meta-分析设计与实施方法[M].第2版.北京:人民卫生出版社,2012,2:97-117.
5曾美钦,林朝春,石灵芳.3种深静脉置管在乳腺癌化疗中的应用效果观察[J].当代护士,2015,11:119-121.
6黄朝青,吴碧钦.PICC和CVC在恶性肿瘤患者中的应用比较[J].当代护士,2014,05:93-94.
7齐敏.PICC和CVC置管技术在恶性肿瘤患者静脉治疗中的应用效果对比[J].临床研究,2015,13(35):136-137.
8陈惠,潘文敏.PICC和CVC置管在恶性肿瘤患者中的应用效果对比[J].中华现代临床护理学杂志,2010,5(6):331-333.
9季梅.PICC和锁骨下静脉置管在肿瘤患者化疗中的应用对比研究[J].当代护士,2012,11:70-71.
10赵勇丽.PICC与CVC在恶性肿瘤病人临床应用中并发症的对比研究[J].内蒙古医科大学学报,2014,36(S1):283-286.
11武素宁,谢兰兰.PICC与CVC在乳癌患者中的应用效果评价[J].科技前沿,2016,07:17-18.
12李瑛.PICC与锁骨下静脉置管在中晚期肿瘤患者中的应用效果比较[J].当代护士,2010,09:82-83.
13王莉.PICC与锁骨下静脉置管在肿瘤和危重患者中的应用效果比较及护理[J].世界最新医学信息文摘,2017,17(56):213-214.
14彭观娣.恶性肿瘤患者行外周导入中心静脉置管与中心静脉置管的效果比较[J].广东医学院学报,2007,25(4):474-475.
15迟娜.恶性肿瘤患者应用PICC和CVC置管的临床观察与护理效果分析[J].中国医药指南,2018,16(14):265-266.
16邹玉芬,张华香.经外周静脉与锁骨下静脉穿刺置管在恶性肿瘤患者中的应用比较[J].中国当代医药,2017,24(16):171-173.
17马丽军,朱翠敏,孙桂华.经外周中心静脉置管术与锁骨下静脉置管在肿瘤患者中的应用比较[J].河北医学,2016,22(1):63-65.
18殷小勇,杨丽丽.外周静脉置入中心静脉导管与经锁骨下静脉置入中心静脉导管在肿瘤化疗患者中的应用效果观察[J].中国煤炭工业医学杂志,2012,15(8):1194-1195.
19李国欣,朱登萍.肿瘤化疗患者PICC与CVC应用比较[J].中华肿瘤防治杂志,2015,22(22):358-360.
20郑雨阳.PICC与CVC在妇科肿瘤化疗患者中的应用比较[J].中国实用医药,2015,10(2):195-196.
21汪素萍,钟小青,游晓燕,等.PICC与锁骨下静脉置管的比较研究[J].护理学杂志,2005,20(8):15-17.
22王爱红,魏素臻,申莹,等.肺癌114例不同静脉通路化疗相关并发症及护理对策[J].齐鲁护理杂志,2008,14(5):22-23.
23焦妙蕊,李景花,郭艳景.两种路径中心静脉置管在老年肿瘤患者中的应用比较[J].中国民康医学,2007,19(6):431-432.
24黄凤形,黄芳艳,韦桂源,等.PICC插管与CVC插管在急性脑血管病人中的应用比较[J].右江医学,2005,33(5):466-468.
25符黎虹,陈丽琴,邹艳.PICC和CVC置管在肿瘤患者化疗的对比观察与护理[J].现代医药卫生杂志,2004,20(16):1612-1613.
26米卫平,宋秋香,孙慧卿,等.PICC与CVC在乳腺癌病人化疗中的应用[J].护理研究,2014,28(10):3676-3677.
27李媛,沙莎.PICC和CVC在肿瘤化疗中应用的效果评价[J].大家健康(学术版),2015,9(5):109-110.
28甘海洁,黎容清,雷奕.PICC和CVC在肿瘤化疗中应用的效果评价[J].中国实用护理杂志,2013,29(2):26-29.
29蒋永红,罗小艳,祝虹,等.经外周静脉中心静脉置管与中心静脉置管在肿瘤患者中的应用[J].现代医药卫生,2016,32(5):763-764.
30徐利.PICC与CVC两种深静脉置管的应用价值对照[J].中国医药指南,2016,14(20):77-78.
31张爱华.PICC与CVC在恶性肿瘤患者治疗中的应用比较[J].护士进修杂志,2014,29(15):1417-1418.
32何正琴,张金花,受珊珊.PICC和CVC置管在恶性肿瘤患者中临床应用效果探析[J].保健文汇,2018,12:69-70.
33胡茶花,杨水秀,袁海珍.两种不同导管在肿瘤患者中心静脉置管中的效果评价[J].实用临床医学,2014,15(9):94-95.
34孙海燕,陈伟红,肖佩华,等.肿瘤患者应用不同方式中心静脉置管的并发症及症状困扰[J].解放军护理杂志,2015,32(13):70-73.
35徐玮蔚,习慧.PICC与CVC拔管的相关因素分析及护理对策[J].当代医学,2015,21(22):109-110.
36杨小娟.外周导入中心静脉置管与中心静脉置管并发症的比较[J].现代护理,2005,11(12):942-943.
37 Loughran SC,Borzatta M.Peripherally inserted central catheters:Areport of 2506 catheter days[J].JPEN,1995,19(2):133-136.
38易诗琼,杨楠,陈金华,唐晨曦.PICC与CVC在肿瘤患者的临床护理效果、并发症及相关时间指标分析[J].国际护理学杂志,2018,37(11):1553-1556.
2戴晓军,徐亮,高晓琴,等.中心静脉置管在中医肿瘤科的临床应用及价值[J].中国当代医药,2014,21(36):18-21.
3 Higgins JPT,Green S.Cochrane Handbook for Systematica Reviews for Interventions 5.1.2[updated March 2011][EB/OL].http://www.cochrane.org/resources/handbook/hbook.thm(accessed2011).
4刘鸣.系统评价、Meta-分析设计与实施方法[M].第2版.北京:人民卫生出版社,2012,2:97-117.
5曾美钦,林朝春,石灵芳.3种深静脉置管在乳腺癌化疗中的应用效果观察[J].当代护士,2015,11:119-121.
6黄朝青,吴碧钦.PICC和CVC在恶性肿瘤患者中的应用比较[J].当代护士,2014,05:93-94.
7齐敏.PICC和CVC置管技术在恶性肿瘤患者静脉治疗中的应用效果对比[J].临床研究,2015,13(35):136-137.
8陈惠,潘文敏.PICC和CVC置管在恶性肿瘤患者中的应用效果对比[J].中华现代临床护理学杂志,2010,5(6):331-333.
9季梅.PICC和锁骨下静脉置管在肿瘤患者化疗中的应用对比研究[J].当代护士,2012,11:70-71.
10赵勇丽.PICC与CVC在恶性肿瘤病人临床应用中并发症的对比研究[J].内蒙古医科大学学报,2014,36(S1):283-286.
11武素宁,谢兰兰.PICC与CVC在乳癌患者中的应用效果评价[J].科技前沿,2016,07:17-18.
12李瑛.PICC与锁骨下静脉置管在中晚期肿瘤患者中的应用效果比较[J].当代护士,2010,09:82-83.
13王莉.PICC与锁骨下静脉置管在肿瘤和危重患者中的应用效果比较及护理[J].世界最新医学信息文摘,2017,17(56):213-214.
14彭观娣.恶性肿瘤患者行外周导入中心静脉置管与中心静脉置管的效果比较[J].广东医学院学报,2007,25(4):474-475.
15迟娜.恶性肿瘤患者应用PICC和CVC置管的临床观察与护理效果分析[J].中国医药指南,2018,16(14):265-266.
16邹玉芬,张华香.经外周静脉与锁骨下静脉穿刺置管在恶性肿瘤患者中的应用比较[J].中国当代医药,2017,24(16):171-173.
17马丽军,朱翠敏,孙桂华.经外周中心静脉置管术与锁骨下静脉置管在肿瘤患者中的应用比较[J].河北医学,2016,22(1):63-65.
18殷小勇,杨丽丽.外周静脉置入中心静脉导管与经锁骨下静脉置入中心静脉导管在肿瘤化疗患者中的应用效果观察[J].中国煤炭工业医学杂志,2012,15(8):1194-1195.
19李国欣,朱登萍.肿瘤化疗患者PICC与CVC应用比较[J].中华肿瘤防治杂志,2015,22(22):358-360.
20郑雨阳.PICC与CVC在妇科肿瘤化疗患者中的应用比较[J].中国实用医药,2015,10(2):195-196.
21汪素萍,钟小青,游晓燕,等.PICC与锁骨下静脉置管的比较研究[J].护理学杂志,2005,20(8):15-17.
22王爱红,魏素臻,申莹,等.肺癌114例不同静脉通路化疗相关并发症及护理对策[J].齐鲁护理杂志,2008,14(5):22-23.
23焦妙蕊,李景花,郭艳景.两种路径中心静脉置管在老年肿瘤患者中的应用比较[J].中国民康医学,2007,19(6):431-432.
24黄凤形,黄芳艳,韦桂源,等.PICC插管与CVC插管在急性脑血管病人中的应用比较[J].右江医学,2005,33(5):466-468.
25符黎虹,陈丽琴,邹艳.PICC和CVC置管在肿瘤患者化疗的对比观察与护理[J].现代医药卫生杂志,2004,20(16):1612-1613.
26米卫平,宋秋香,孙慧卿,等.PICC与CVC在乳腺癌病人化疗中的应用[J].护理研究,2014,28(10):3676-3677.
27李媛,沙莎.PICC和CVC在肿瘤化疗中应用的效果评价[J].大家健康(学术版),2015,9(5):109-110.
28甘海洁,黎容清,雷奕.PICC和CVC在肿瘤化疗中应用的效果评价[J].中国实用护理杂志,2013,29(2):26-29.
29蒋永红,罗小艳,祝虹,等.经外周静脉中心静脉置管与中心静脉置管在肿瘤患者中的应用[J].现代医药卫生,2016,32(5):763-764.
30徐利.PICC与CVC两种深静脉置管的应用价值对照[J].中国医药指南,2016,14(20):77-78.
31张爱华.PICC与CVC在恶性肿瘤患者治疗中的应用比较[J].护士进修杂志,2014,29(15):1417-1418.
32何正琴,张金花,受珊珊.PICC和CVC置管在恶性肿瘤患者中临床应用效果探析[J].保健文汇,2018,12:69-70.
33胡茶花,杨水秀,袁海珍.两种不同导管在肿瘤患者中心静脉置管中的效果评价[J].实用临床医学,2014,15(9):94-95.
34孙海燕,陈伟红,肖佩华,等.肿瘤患者应用不同方式中心静脉置管的并发症及症状困扰[J].解放军护理杂志,2015,32(13):70-73.
35徐玮蔚,习慧.PICC与CVC拔管的相关因素分析及护理对策[J].当代医学,2015,21(22):109-110.
36杨小娟.外周导入中心静脉置管与中心静脉置管并发症的比较[J].现代护理,2005,11(12):942-943.
37 Loughran SC,Borzatta M.Peripherally inserted central catheters:Areport of 2506 catheter days[J].JPEN,1995,19(2):133-136.
38易诗琼,杨楠,陈金华,唐晨曦.PICC与CVC在肿瘤患者的临床护理效果、并发症及相关时间指标分析[J].国际护理学杂志,2018,37(11):1553-1556.