CAJ | 학술논문

目的：比较经外周静脉穿刺中心静脉置管（PICC）与植入式静脉输液港（VPA）在恶性肿瘤患者中的应用效果及利弊，拟确立两种方法各自的适用人群。方法由两位独立评价者按检索策略检索中国生物医学文献库、中国期刊全文数据库、M edline等资源中已发表及未发表文献，研究人群为中国人。根据纳入标准筛选相关研究，评价研究质量后用Stata 12．0软件进行分析，分析指标为并发症、首次置管成功率及置管时间。结果共纳入12项研究，总病例数1228例。结果显示：恶性肿瘤患者使用VPA长期静脉输液并发症发生率显著低于PICC患者[OR＝0．25，95％ CI（0．17～0．36），P＜0．01]，VPA患者组管路堵塞移位的发生率显著高于PICC组[OR＝2．03，95％CI（1．04～3．97），P＝0．037]，静脉炎及局部感染发生率显著低于PICC组[OR＝0．49，95％ CI（0．25～0．96），P＝0．037]；VPA组患者首次置管成功率低于 PICC组[OR＝0．68，95％ CI（0．41～1．13），P＝0．138]；VPA组留置时间超过一年的患者显著多于PICC组[OR＝39．11，95％ CI（14．32～106．84），P＜0．01]。结论采用VPA长期静脉输液较PICC具有更低的并发症发生率、更长的留置时间，但V PA一次置管成功率较低，综合考虑，更适合一年以上长期静脉输液的患者应用。
목적：비교경외주정맥천자중심정맥치관（PICC）여식입식정맥수액항（VPA）재악성종류환자중적응용효과급리폐，의학립량충방법각자적괄용인군。방법유량위독립평개자안검색책략검색중국생물의학문헌고、중국기간전문수거고、M edline등자원중이발표급미발표문헌，연구인군위중국인。근거납입표준사선상관연구，평개연구질량후용Stata 12．0연건진행분석，분석지표위병발증、수차치관성공솔급치관시간。결과공납입12항연구，총병례수1228례。결과현시：악성종류환자사용VPA장기정맥수액병발증발생솔현저저우PICC환자[OR＝0．25，95％ CI（0．17～0．36），P＜0．01]，VPA환자조관로도새이위적발생솔현저고우PICC조[OR＝2．03，95％CI（1．04～3．97），P＝0．037]，정맥염급국부감염발생솔현저저우PICC조[OR＝0．49，95％ CI（0．25～0．96），P＝0．037]；VPA조환자수차치관성공솔저우 PICC조[OR＝0．68，95％ CI（0．41～1．13），P＝0．138]；VPA조류치시간초과일년적환자현저다우PICC조[OR＝39．11，95％ CI（14．32～106．84），P＜0．01]。결론채용VPA장기정맥수액교PICC구유경저적병발증발생솔、경장적류치시간，단V PA일차치관성공솔교저，종합고필，경괄합일년이상장기정맥수액적환자응용。
Objective To compare the application effect ,advantages and disadvantages between peripheral vein puncture central venous catheter (PICC) and implantable venous port (VPA) for patients with tumor .Method Ran‐domized controlled trials were collected from different databases according to inclusion and exclusion criteria by two independent researchers .Meta analysis was performed by Stata 12 .0 software after quality evaluation of the articles , and the evaluation indexes were complications ,success rate and time .Result 1228 patients from 12 randomized clini‐cal trials were included .The results showed that malignant tumor patients with long term use of intravenous infu‐sion by VPA in the incidence of complications were significantly lower than that of PICC[OR=0 .25 ,95% CI (0 .17~0 .36) ,P<0 .001] .The incidence of catheter occlusion and displacement in the VPA group was significantly high‐er than that of PICC group [OR=2 .03 ,95% CI(1 .04~3 .97) ,P=0 .037] ,and the incidence of Phlebitis and local infection in the VPA group was significantly lower than that of PICC group[OR=0 .49 ,95% CI(0 .25~0 .96) ,P=0 .037] .Intubation success rate for the first time in the VPA group was lower than that of PICC group[OR=0 .68 , 95% CI(0 .41~1 .13) ,P=0 .138] .The patients with piping indwelling time more than a year in the VPA group was significantly more than PICC group[OR=39 .11 ,95% CI(14 .32~106 .84) ,P<0 .001] .Compared with PICC ,long term Conclusion Compared with PICC ,long term intravenous infusion using VPA has a lower incidence of complica‐tions ,however a lower intubation success rate for the first time ,and more suitable for long term intravenous infu‐sion over one year .