CAJ | 학술논문

目的系统评价植入式静脉输液港(VPA)与经外周静脉穿刺中心静脉置管(PICC)在恶性肿瘤患者化疗中应用的相关研究,分析2种置管方式在临床应用中的差异.方法计算机检索PubMed、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、维普期刊全文数据库(VIP),按Cochrane系统评价方法筛选文献、评价质量、提取资料,并用RevMan 5.2软件进行Meta分析.结果纳入29项研究,共4 449例患者,其中实验组1 912例(采用VPA),对照组2 537例(采用PICC).实验组导管平均留置时间[标准化均数差(SMD)=3.36,95％可信区间(CI) 2.51～4.21,P＜0.01]、生命质量[相对危险度(RR)=1.61,95％CI 1.15～2.24,P＜0.01]均明显优于对照组,差异有统计学意义;实验组并发症总发生率(RR =0.26,95％CI 0.20～0.34,P＜0.01)、静脉炎发生率(RR =0.08,95 ％CI 0.04～0.16,P＜0.01)、导管感染发生率(RR=0.32,95％CI 0.23～0.44,P＜0.01)、导管堵塞发生率(RR=0.32,95％CI0.22～0.48,P＜0.01)、导管移位发生率(RR=0.18,95％CI 0.09～0.37,P＜0.01)均显著低于对照组,但在首次置管成功率、渗血或血肿发生率、血栓发生率、导管渗漏发生率方面,2组比较差异无统计学意义,P＞0.05.结论与PICC相比,VPA留置时间长,并发症发生率低,且对患者带管期间的生命质量影响较小,在恶性肿瘤患者的化学治疗中值得广泛推广.
목적 계통평개식입식정맥수액항(VPA)여경외주정맥천자중심정맥치관(PICC)재악성종류환자화료중응용적상관연구,분석2충치관방식재림상응용중적차이.방법 계산궤검색PubMed、중국기간전문수거고(CNKI)、중국생물의학문헌수거고(CBM)、만방수거고、유보기간전문수거고(VIP),안Cochrane계통평개방법사선문헌、평개질량、제취자료,병용RevMan 5.2연건진행Meta분석.결과 납입29항연구,공4 449례환자,기중실험조1 912례(채용VPA),대조조2 537례(채용PICC).실험조도관평균류치시간[표준화균수차(SMD)=3.36,95％가신구간(CI) 2.51～4.21,P＜0.01]、생명질량[상대위험도(RR)=1.61,95％CI 1.15～2.24,P＜0.01]균명현우우대조조,차이유통계학의의;실험조병발증총발생솔(RR =0.26,95％CI 0.20～0.34,P＜0.01)、정맥염발생솔(RR =0.08,95 ％CI 0.04～0.16,P＜0.01)、도관감염발생솔(RR=0.32,95％CI 0.23～0.44,P＜0.01)、도관도새발생솔(RR=0.32,95％CI0.22～0.48,P＜0.01)、도관이위발생솔(RR=0.18,95％CI 0.09～0.37,P＜0.01)균현저저우대조조,단재수차치관성공솔、삼혈혹혈종발생솔、혈전발생솔、도관삼루발생솔방면,2조비교차이무통계학의의,P＞0.05.결론 여PICC상비,VPA류치시간장,병발증발생솔저,차대환자대관기간적생명질량영향교소,재악성종류환자적화학치료중치득엄범추엄.
Objective To analyze the difference of the venous port access (VPA) and peripherally inserted central catheter (PICC) in cancer chemotherapy.Methods All eligible studies on VPA and PICC were searched in the databases of PubMed,China National Knowledge Internet (CNKI),Chinese Biomedical Database (CBM),WANFANG Database and VIP Database.Literatures screening,quality evaluation and data extraction were conducted according to Cochrane Handbook;Meta-analysis was calculated by using RevMan 5.2.Results Twenty-nine studies with a total of 4 449 cases of patients were included in this Meta-analysis,with 1 912 cases in experimental group which adopted VPA and 2 537 cases in controlled group which adopted PICC.Experimental group had advantages in the average catheter retention time (SMD=3.36,95％CI 2.51-4.21) and quality of life (RR=1.61,95％CI 1.15-2.24) compared with controlled group.The overall complication rate (RR=0.26,95％CI 0.20-0.34,P＜0.01),phlebitis incidence (RR=0.08,95％CI 0.04-0.16,P＜0.01),catheter infection incidence (RR=0.32,95％CI 0.23-0.44,P＜0.01),catheter obstruction incidence (RR=0.32,95％CI 0.22-0.48,P＜0.01),catheter dystopy incidence (RR=0.18,95％CI 0.09-0.37,P＜0.01) in experimental group were remarkably lower than that in controlled group.However,no significant difference was found between the two groups in the incidence of the puncture success rate for the first time,errhysis or hematoncus,thrombus and catheter leakage (P ＞0.05).Conclusions Compared with PICC,VPA had advantages in a long retention time,fewer complications and few influence on quality of life.Therefore,VPA should be widely used in cancer chemotherapy.