CAJ | 학술논문

目的探究在使用长期留置导管的透析患者中,枸橼酸封管液是否在预防导管相关感染、出血并发症、导管功能障碍等方面优于传统肝素封管液.方法检索Pubmed、the Cochrane Library、EMBASE、Ovid、万方、维普、CNKI、CBM等数据库和相关杂志中符合纳入标准的随机对照试验,并使用Revman 5.0和STATA 10.0软件进行Meta分析.研究终点指标包括导管相关感染、出血、溶栓治疗次数、功能障碍所致拔管、血栓形成、全因死亡率.结果共纳入15篇随机对照试验(1621例患者),其中8篇研究比较单纯枸橼酸封管液与肝素封管液的差异,其他7篇研究则关注枸橼酸和其他抗菌药物的复合配方封管液.Meta分析结果显示,使用枸橼酸封管的患者发生导管相关感染的概率较使用肝素封管的患者下降了47％,差异有统计学意义(RR=0.53,95％CI 0.36～ 0.77,P＜0.01).按照封管液配方进行亚组分析发现,各类含抗菌药物的复合枸橼酸封管液(枸橼酸+庆大霉素、枸橼酸+牛磺罗定、枸橼酸+亚甲基蓝+羟苯甲酯+羟苯丙酯)预防导管相关感染的效果均优于传统肝素封管液(P分别为0.01、0.04、0.01)；单纯枸橼酸封管组的导管相关感染风险虽然低于肝素组(RR=0.68),但差异尚无统计学意义(95％CI 0.38～ 1.21,P=0.19).枸橼酸组患者出血并发症显著少于肝素组(RR=0.53,95％CI 0.34～ 0.84,P＜0.01),而两组在溶栓治疗次数(P=0.93)、功能障碍所致拔管(P=0.35)、血栓形成(P=0.64)、全因死亡率(P=0.35)等方面差异均无统计学意义.结论枸橼酸联用抗菌药物封管可降低长期留置导管相关感染风险,而单用枸橼酸封管与使用肝素封管的差异无统计学意义.枸橼酸封管液在控制出血并发症方面优于肝素,预防导管功能障碍的效果与肝素类似.
목적 탐구재사용장기류치도관적투석환자중,구연산봉관액시부재예방도관상관감염、출혈병발증、도관공능장애등방면우우전통간소봉관액.방법 검색Pubmed、the Cochrane Library、EMBASE、Ovid、만방、유보、CNKI、CBM등수거고화상관잡지중부합납입표준적수궤대조시험,병사용Revman 5.0화STATA 10.0연건진행Meta분석.연구종점지표포괄도관상관감염、출혈、용전치료차수、공능장애소치발관、혈전형성、전인사망솔.결과 공납입15편수궤대조시험(1621례환자),기중8편연구비교단순구연산봉관액여간소봉관액적차이,기타7편연구칙관주구연산화기타항균약물적복합배방봉관액.Meta분석결과현시,사용구연산봉관적환자발생도관상관감염적개솔교사용간소봉관적환자하강료47％,차이유통계학의의(RR=0.53,95％CI 0.36～ 0.77,P＜0.01).안조봉관액배방진행아조분석발현,각류함항균약물적복합구연산봉관액(구연산+경대매소、구연산+우광라정、구연산+아갑기람+간분갑지+간분병지)예방도관상관감염적효과균우우전통간소봉관액(P분별위0.01、0.04、0.01)；단순구연산봉관조적도관상관감염풍험수연저우간소조(RR=0.68),단차이상무통계학의의(95％CI 0.38～ 1.21,P=0.19).구연산조환자출혈병발증현저소우간소조(RR=0.53,95％CI 0.34～ 0.84,P＜0.01),이량조재용전치료차수(P=0.93)、공능장애소치발관(P=0.35)、혈전형성(P=0.64)、전인사망솔(P=0.35)등방면차이균무통계학의의.결론 구연산련용항균약물봉관가강저장기류치도관상관감염풍험,이단용구연산봉관여사용간소봉관적차이무통계학의의.구연산봉관액재공제출혈병발증방면우우간소,예방도관공능장애적효과여간소유사.
Objective To study whether citrate lock is superior to heparin lock in the prevention of catheter related infections,bleeding complications and catheter malfunctions among hemodialysis patients with tunneled catheters.Methods By searching in Pubmed,the Cochrane Library,EMBASE,Ovid,WanFang,VIP,CNKI and CBM databases as well as related journals,qualified randomized controlled trials were included in a Meta-analysis using Revman 5.0 and STATA 10.0 software.The endpoints included catheter related infection,bleeding complication,thrombolytic treatment,catheter removal for malfunction,catheter thrombosis and all-cause death.Results Fifteen randomized controlled trials were included with 1621 patients involved.Eight studies compared citrate alone with heparin lock,while 7 trials focused on citrate in combination with other antimicrobials.Pooled analysis demonstrated that incidence of catheter related infections in patients receiving citrate lock decreased by 47％ compared with those on heparin (RR=0.53,95％CI 0.36-0.77,P ＜ 0.01).Subgroup analysis by types of citrate lock indicated that all combined lock solutions of citrate and other antimicrobials (citrate + gentamicin,citrate + taurolidine,citrate + methylene blue +methylparaben + propylparaben) were superior to heparin lock in preventing catheter-related infections (P =0.01,0.04,0.01,respectively); citrate alone seemed to reduce catheter-related infection risk (RR =0.68),but no statistically significant difference was observed (95％CI 0.38-1.21,P=0.19).There were fewer patients with bleeding complications in citrate group (RR =0.53,95％ CI 0.34-0.S4,P ＜ 0.01),while citrate showed no advantage over heparin lock in terms of thrombolytic treatment (P =0.93),catheter removal for malfunction (P =0.35),catheter thrombosis (P =0.64) and all-cause death (P =0.35).Conclusions For hemodialysis patients with tunneled catheters,combined lock solutions of citrate and other antimicrobials,rather than citrate alone,are superior to heparin in preventing catheter related infections.Citrate locks are associated with less bleeding complications,and are comparable to heparin in the maintenance of catheter patency.