肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析
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摘要
目的通过Meta分析明确肿瘤患者PICC置管相关静脉血栓形成的危险因素,为预防及降低肿瘤患者PICC置管相关静脉血栓形成提供参考依据。方法在中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库、百度文库、PubMed、EMbase、Web of Science、Medline、Cochrane中进行文献检索,检索时间为开始收录时间起到2018年11月并进行文献质量评价,应用Stata 13.0对国内外有关肿瘤患者PICC置管相关静脉血栓形成危险因素的病例对照研究及队列研究进行Meta分析,用Egger线性回归法判定发表偏倚。结果共纳入18篇文献,总病例6 425例,病例组/暴露组825例,对照组/非病例组5 600例。危险因素合并OR值分别为:年龄≥60岁2.560(95%CI:1.653～3.967)、超重或肥胖3.552(95%CI:2.103～5.998)、合并高血压2.041(95%CI:1.302～3.200)、合并糖尿病2.021(95%CI:1.695～2.409)、PICC置管史2.188(95%CI:1.204～3.976)、置管期间放疗4.308 (95%CI:1.901～9.763)、活动量少4.559 (95%CI:1.035～20.085)、感染2.748 (95%CI:1.397～5.408)、肿瘤分期为Ⅲ～Ⅳ期2.746(95%CI:1.643～4.589)、肿瘤转移4.023(95%CI:1.895～8.544)。Egger线性回归法分析显示,活动量少、肿瘤转移、置管期间放疗存在一定发表偏倚。结论年龄≥60岁、超重或肥胖、合并高血压、合并糖尿病、PICC置管史、感染、肿瘤分期为Ⅲ～Ⅳ期为肿瘤患者PICC置管相关静脉血栓形成的危险因素,活动量少、肿瘤转移、置管期间放疗作为肿瘤患者PICC置管相关静脉血栓的危险因素的证据尚不充分。应对肿瘤患者中存在的可改变危险因素进行早期干预,加强监测不可改变危险因素。
Objective To identify the risk factors of PICC-related venous thrombosis in cancer patients through meta analysis and provide reference for the prevention and reduce of PICC-related venous thrombosis. Methods We retrieved CNKI, CBM, Wangfang Datbase, VIP, Baidu Library, PubMed, Embase, Web of Science, Medline, Cochrane from the inception to November 2018 to collect case-control studies and cohort studies on risk factors of PICC-related venous thrombosis in cancer patients. Meta analysis was performed by using Stata 13.0 and the Egger's linear regression to test publication bias. Results There were 18 included articles of 6, 425 patients, 825 in case group/exposed group and 5, 600 in control group/non-case group. Risk factors and OR value were as follows: aged over 60, 2.560(95%CI:1.653～3.967); overweight or obesity, 3.552(95%CI:2.103～5.998), combined with hypertension,2.041(95%CI:1.302～3.200), combined with diabetes, 2.021(95%CI:1.695～2.409), a history of PICC, 2.188(95%CI:1.204～3.976),having radiotherapy with PICC, 4.308(95%CI:1.901～9.763), inadequate activity, 4.559(95%CI:1.035～20.085), infection, 2.748(95%CI:1.397～5.408), TNM stage III to IV 2.746(95%CI:1.643～4.589) and tumor metastasis, 4.023(95% CI:1.895～8.544). Egger's linear regression showed that publication bias was found pertaining to inadequate activity, tumor metastasis and having radiotherapy with PICC. Conclusion Risk factors of PICC-related venous thrombosis in cancer patients include aged over 60, overweight or obesity,combined with hypertension or diabetes, a history of PICC, infection and TNM stage III to IV but there are not adequate evidences for risk factors such as inadequate activity, tumor metastasis and having radiotherapy with PICC. Early intervention should be performed for changeable risk factors and more monitoring for unchangeable ones.
Objective To identify the risk factors of PICC-related venous thrombosis in cancer patients through meta analysis and provide reference for the prevention and reduce of PICC-related venous thrombosis. Methods We retrieved CNKI, CBM, Wangfang Datbase, VIP, Baidu Library, PubMed, Embase, Web of Science, Medline, Cochrane from the inception to November 2018 to collect case-control studies and cohort studies on risk factors of PICC-related venous thrombosis in cancer patients. Meta analysis was performed by using Stata 13.0 and the Egger's linear regression to test publication bias. Results There were 18 included articles of 6, 425 patients, 825 in case group/exposed group and 5, 600 in control group/non-case group. Risk factors and OR value were as follows: aged over 60, 2.560(95%CI:1.653～3.967); overweight or obesity, 3.552(95%CI:2.103～5.998), combined with hypertension,2.041(95%CI:1.302～3.200), combined with diabetes, 2.021(95%CI:1.695～2.409), a history of PICC, 2.188(95%CI:1.204～3.976),having radiotherapy with PICC, 4.308(95%CI:1.901～9.763), inadequate activity, 4.559(95%CI:1.035～20.085), infection, 2.748(95%CI:1.397～5.408), TNM stage III to IV 2.746(95%CI:1.643～4.589) and tumor metastasis, 4.023(95% CI:1.895～8.544). Egger's linear regression showed that publication bias was found pertaining to inadequate activity, tumor metastasis and having radiotherapy with PICC. Conclusion Risk factors of PICC-related venous thrombosis in cancer patients include aged over 60, overweight or obesity,combined with hypertension or diabetes, a history of PICC, infection and TNM stage III to IV but there are not adequate evidences for risk factors such as inadequate activity, tumor metastasis and having radiotherapy with PICC. Early intervention should be performed for changeable risk factors and more monitoring for unchangeable ones.
引文
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[2]朱丽群,庄若,曹松梅,等.PICC相关性血栓风险评估的最佳证据总结[J].中华护理杂志,2017,52(10):1179-1185.DOI:10.3761/j.issn.0254-1769.2017.10.005.
[3]王丽丽,王金荣,高攀,等.中心静脉置入设备相关上肢深静脉血栓形成的诊断、预防和治疗[J].中国呼吸与危重监护杂志,2018,17(5):532-538.DOI:10.7507/1671-6205.201710007.
[4]Jones D,Wismayer K,Bozas G,et al.The Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters in Ambulant Cancer Patients[J].Thromb J,2017(15):25.DOI:10.1186/s12959-017-0148-y.
[5]于瑞,陈利芬.肿瘤患者PICC导管相关静脉血栓形成影响因素Meta分析[J].中国护理管理,2016,16(6):738-743.DOI:10.3969/j.issn.1672-1756.2016.06.005.
[6]秦霞,田利,李惠玲,等.内科住院病人发生静脉血栓栓塞症危险因素的Meta分析[J].现代预防医学,2018,45(4):753-756.
[7]Wells G,Shea B,O’Connell D,et al.The Newcastle-ottawa Scale(NOS)for Assessing the Quality of Non-randomised Studies in Meta-analyses[EB/OL].(2018-02-26)[2018-03-18].http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
[8]刘聿秀.肿瘤患者PICC相关上肢静脉血栓及其危险因素的研究[D].青岛:青岛大学,2010.
[9]李琦.肿瘤患者PICC相关上肢静脉血栓形成的临床分析[D].杭州:浙江大学,2015.
[10]于瑞,陈利芬,周雪梅,等.肿瘤患者PICC导管相关血栓形成危险因素的研究[J].中国护理管理,2016,16(10):1326-1330.DOI:DOI:10.3969/j.issn.1672-1756.2016.10.008.
[11]邢淑云.肿瘤患者PICC相关性血栓发生状况的临床观察及相关因素分析[D].青岛:青岛大学,2017.
[12]原娜,王磊,武雪亮.肺癌化疗患者经外周中心静脉置管术相关性静脉血栓的危险因素分析[J].中国医药导报,2017,14(26):86-89,97.
[13]张丽,陆箴琦,陆海燕,等.肿瘤患者PICC导管相关性血栓形成的相关因素分析[J].护理学杂志,2017,32(14):51-55.DOI:10.3870/j.issn.1001-4152.2017.14.051.
[14]关晨阳,廖海涛,高文,等.肿瘤病人PICC导管相关性血栓的危险因素分析[J].护理研究,2017,31(10):1211-1215.DOI:10.3969/j.issn.1009-6493.2017.10.017.
[15]宋轶凡.肿瘤患者PICC置管术后上肢静脉血栓形成的相关因素研究[J].基层医学论坛,2018,22(26):3748-3750.DOI:10.19435/j.1672-1721.2018.26.080.
[16]张伟伟,方云.血液肿瘤患者PICC导管相关性血栓形成的危险因素分析[J].临床血液学杂志,2018,31(2):197-200.DOI:10.13201/j.issn.1004-2806.2018.03.008.
[17]Shi Y,Wen L,Zhou Y,et al.Thrombotic Risk Factors in Patients Undergoing Chemotherapy Via Peripherally Inserted Central Catheter[J].J Int Med Res,2014,42(3):863-9.DOI:10.1177/0300060514527061.
[18]Liu Y,Gao Y,Wei L,et al.Peripherally Inserted Central Catheter Thrombosis Incidence and Risk Factors in Cancer Patients:A Double-center Prospective Investigation[J].Ther Clin Risk Manag,2015(11):153-160.DOI:10.2147/TCRM.S73379.
[19]Kang J,Sun W,Li H,et al.Peripherally Inserted Central Catheter-related Vein Thrombosis in Breast Cancer Patients[J].J Vasc Access,2016,17(1):67-71.DOI:10.5301/jva.5000457.
[20]Kang J R,Long L H,Yan S W,et al.Peripherally Inserted Central Catheter-related Vein Thrombosis in Patients with Lung Cancer[J].Clin Appl Thromb Hemost,2017,23(2):181-186.DOI:10.1177/1076029615595880.
[21]Aw A,Carrier M,Koczerginski J,et al.Incidence and Predictive Factors of Symptomatic Thrombosis Related to Peripherally Inserted Central Catheters In Chemotherapy Patients[J].Thromb Res,2012,130(3):323-326.DOI:10.1016/j.thromres.2012.02.048.
[22]Ahn D H,Illum H B,Wang D H,et al.Upper Extremity Venous Thrombosis in Patients with Cancer with Peripherally Inserted Central Venous Catheters:A Retrospective Analysis of Risk Factors[J].J Oncol Pract,2013,9(1):e8-12.DOI:10.1200/JOP.2012.000595.
[23]Yi X L,Chen J,Li J,et al.Risk Factors Associated with PICC-related Upper Extremity Venous Thrombosis in Cancer Patients[J].J Clin Nurs,2014,23(5/6):837-843.DOI:10.1111/jocn.12227.
[24]Liang Y J,He Y,Li J M,et al.The Incidence and Predictors of Symptomatic Venous Thromboembolism Associated with Peripherally Inserted Central Catheters in Patients with Nasopharyngeal Carcinoma[J].Onco Targets Ther,2018(11):3119-3127.DOI:10.2147/OTT.S164723.
[25]李斌,颜秀英,刘寿,等.老年人消化性溃疡危险因素的Meta分析[J].现代预防医学,2017,44(8):1371-1376.
[26]Oger E,Leroyer C,Le Moigne E,et al.The Value of a Risk Factor Analysis in Clinically Suspected Deep Venous Thrombosis[J].Respiration,1997(64):326-330.
[27]中国临床肿瘤学会肿瘤与血栓专家共识委员会.中国肿瘤相关静脉血栓栓塞症预防与治疗专家指南(2015版)[J].中国实用内科杂志,2015,35(11):907-920.DOI:10.7504/nk2015100201.
[28]周晔,刘扣英,崔焱.握拳频次对PICC置管病人上肢静脉血液流速的影响[J].护理研究,2016,30(5C):1838-1840.DOI:10.3969/j.issn.1009-6493.2016.15.015.
[29]李雪娇,王健,皮红英.上肢加压对经外周置入中心静脉导管患者血流动力学影响的研究[J].解放军护理杂志,2018,35(18):46-49.DOI:10.3969/j.issn.1008-9993.2018.18.010.
[30]金咏梅,邸英莲,徐春静,等.温和灸对胃肠道恶性肿瘤患者PICC相关性上肢静脉血栓预防的效果研究[J].中华护理杂志,2017,52(7):854-857.DOI:10.3761/j.issn.0254-1769.2017.07.018.
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