新生儿上肢静脉与下肢静脉PICC置管效果比较的Meta分析

陈秀文; 周乐山; 谭彦娟; 陈羽双; 陶子荣

doi:10.7499/j.issn.1008-8830.2019.12.003

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中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (12) : 1164-1171. DOI: 10.7499/j.issn.1008-8830.2019.12.003

论著·临床研究

新生儿上肢静脉与下肢静脉PICC置管效果比较的Meta分析

陈秀文¹, 周乐山², 谭彦娟³, 陈羽双², 陶子荣¹

作者信息 +

Effect of placement of peripherally inserted central catheter via the upper versus lower extremity veins: a Meta analysis

CHEN Xiu-Wen¹, ZHOU Le-Shan², TAN Yan-Juan³, CHEN Yu-Shuang², TAO Zi-Rong¹

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文章历史 +

摘要

目的通过Meta分析方法比较新生儿经上肢静脉和经下肢静脉行经外周置入中心静脉导管（PICC）的置管效果。方法检索中国知网、万方、维普中文科技期刊、中国生物医学文献以及PubMed、Web of Knowledge、EMBASE、Medline、Cochrane图书馆、Google Scholar等数据库中有关新生儿经上肢静脉行PICC与经下肢静脉行PICC置管效果比较的对照研究，采用RevMan 5.3软件对符合要求的研究进行Meta分析。结果共纳入18项研究，其中8项为随机对照研究，10项为队列研究，包含研究对象4 890例。经下肢静脉行PICC组的并发症发生率（RR=0.83，95% CI：0.75~0.92，P < 0.05）、感染发生率（RR=0.77，95% CI：0.60~0.99，P < 0.05）、导管异位发生率（RR=0.28，95% CI：0.18~0.42，P < 0.05）、液体渗漏发生率（RR=0.52，95% CI：0.40~0.70，P < 0.05）、非计划性拔管率（RR=0.82，95% CI：0.69~0.98，P < 0.05）均低于经上肢静脉PICC组，一次穿刺成功率高于上肢静脉PICC组（RR=1.17，95% CI：1.05~1.30，P < 0.05），留置时间短于上肢静脉组（MD= -0.93，95% CI：-1.26~0.60，P < 0.05）。结论目前证据表明，新生儿经下肢静脉行PICC优于上肢静脉。

Abstract

Objective To investigate the effect of placement of peripherally inserted central catheter (PICC) via the upper versus lower extremity veins in neonates through a Meta analysis. Methods CNKI, Wanfang Data, VIP Data, CBMdisc, PubMed, Web of Knowledge, Embase, Medline, Cochrane Library and Google Scholar were searched for control studies on the effect of PICC placement via the upper versus lower extremity veins in neonates. RevMan 5.3 was used to perform a Meta analysis of the studies which met the inclusion criteria. Results A total of 18 studies were included, among which there were 8 randomized controlled trials and 10 cohort studies, with 4 890 subjects in total. Compared with those undergoing PICC placement via the upper extremity veins, the neonates undergoing PICC placement via the lower extremity veins had significantly lower incidence rates of complications (RR=0.83, 95%CI:0.75-0.92, P < 0.05), catheter-related infections (RR=0.77, 95%CI:0.60-0.99, P < 0.05), catheter malposition (RR=0.28, 95%CI:0.18-0.42, P < 0.05), extravasation of the infusate (RR=0.52, 95%CI:0.40-0.70, P < 0.05), and unplanned extubation (RR=0.82, 95%CI:0.69-0.98, P < 0.05). They also had a significantly higher first-attempt success rate of puncture (RR=1.17, 95%CI:1.05-1.30, P < 0.05) and a significantly shorter PICC indwelling time (MD=-0.93, 95%CI:-1.26-0.60, P < 0.05). Conclusions The above evidence shows that PICC placement via the lower extremity veins has a better effect than PICC placement via the upper extremity veins in neonates.

导出引用

陈秀文, 周乐山, 谭彦娟, 陈羽双, 陶子荣. 新生儿上肢静脉与下肢静脉PICC置管效果比较的Meta分析[J]. 中国当代儿科杂志. 2019, 21(12): 1164-1171 https://doi.org/10.7499/j.issn.1008-8830.2019.12.003

CHEN Xiu-Wen, ZHOU Le-Shan, TAN Yan-Juan, CHEN Yu-Shuang, TAO Zi-Rong. Effect of placement of peripherally inserted central catheter via the upper versus lower extremity veins: a Meta analysis[J]. Chinese Journal of Contemporary Pediatrics. 2019, 21(12): 1164-1171 https://doi.org/10.7499/j.issn.1008-8830.2019.12.003

参考文献

[1] 陈秀文, 李辉, 谭彦娟, 等. 新生儿PICC相关性血栓的研究进展[J]. 中华护理杂志, 2017, 52(8):991-996.
[2] Erhard DM, Nguyen S, Guy KJ, et al. Dwell times and risk of non-elective removal of 1-French peripherally inserted central catheters according to catheter tip position in very preterm infants[J]. Eur J Pediatr, 2017, 176(3):407-411.
[3] 盛美君, 程晓英, 楼晓芳, 等. 新生儿左侧髂-股静脉血栓的早期护理干预[J]. 中华护理杂志, 2015, 50(1):119-120.
[4] Yu X, Yue S, Wang M, et al. Risk factors related to peripherally inserted central venous catheter nonselective removal in neonates[J]. Biomed Res Int, 2018, 2018:3769376.
[5] Johnson KN, Thomas T, Grove J, et al. Insertion of peripherally inserted central catheters in neonates less than 1.5 kg using ultrasound guidance[J]. Pediatr Surg Int, 2016, 32(11):1053-1057.
[6] 唐红梅, 张惠英, 文凤, 等. 新生儿经外周静脉置入中心静脉导管的临床观察及应用分析[J]. 护理研究, 2015, 29(7A):2396-2398.
[7] Bashir RA, Swarnam K, Vayalthrikkovil S, et al. Association between peripherally inserted central venous catheter insertion site and complication rates in preterm infants[J]. Am J Perinatol, 2016, 33(10):945-950.
[8] Freeman JJ, Gadepalli SK, Siddiqui SM, et al. Improving central line infection rates in the neonatal intensive care unit:effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols[J]. J Pediatr Surg, 2015, 50(5):860-863.
[9] Zhou LJ, Xua HZ, Xu MF, et al. An accuracy study of the intracavitary electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates[J]. Open Med (Wars), 2017, 12:125-130.
[10] 肖艾青, 张榕, 凃满梅, 等. 不同路径经外周静脉置入中心静脉导管在早产儿治疗中的应用[J]. 解放军护理杂志, 2016, 33(17):23-25.
[11] 明静. 不同外周静脉置入中心静脉导管置管途径应用于新生儿的效果对比及临床分析[J]. 中国医药导报, 2014, 11(1):116-118.
[12] 梁必会, 刘建红, 黄丽雅, 等. 新生儿采用不同静脉留置PICC的临床效果及安全性研究[J]. 护理研究, 2016, 30(25):3172-3174.
[13] 李力, 曾从容, 杨春雪, 等. 新生儿下肢静脉PICC可行性研究[J]. 中国实用护理杂志, 2014, 30(7):51-52.
[14] 郭舒文, 谢丽琴, 陈开珠, 等. 早产儿右下肢静脉PICC送管方法的改进[J]. 护理学杂志, 2014, 29(8):13-15.
[15] Hoang V, Sills J, Chandler M, et al. Percutaneously inserted central catheter for total parenteral nutrition in neonates:complications rates related to upper versus lower extremity insertion[J]. Pediatrics, 2008, 121(5):e1152-e1159.
[16] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605.
[17] 徐海萍, 周琴, 韩伟, 等. 手臂输液港与胸壁输液港常见并发症发生率比较的Meta分析[J]. 中华护理杂志, 2018, 53(3):352-358.
[18] 刘鸣. 系统评价、Meta-分析设计与实施方法[M]. 北京:人民卫生出版社, 2011:97-108.
[19] 孙振球, 徐勇勇. 医学统计学[M]. 北京:人民卫生出版社, 2014:631-637.
[20] 郭舒文, 谢丽琴, 许丽萍, 等. 早产儿经右下肢静脉留置PICC导管的可行性[J]. 中华护理杂志, 2012, 47(2):153-156.
[21] 马繁荣. 经外周静脉置入中心静脉导管不同置管方式在新生儿中的应用[J]. 实用临床医药杂志, 2015, 19(14):169-170.
[22] 李莉, 谭玮, 赖胜华, 等. 早产儿PICC两种置管途径的效果分析[J]. 基层医学论坛, 2016, 20(36):5184-5185.
[23] 沈红五, 缪爱梅, 茅志娟, 等. PICC两种置管途径在新生儿中应用的效果分析[J]. 护士进修杂志, 2013, 28(4):351-353.
[24] 陈丽莲, 熊小云, 郝彦斌, 等. 新生儿经大隐静脉置入中心静脉导管的研究[J]. 全科护理, 2012, 10(7A):1734-1736.
[25] van den Berg J, Lööf Aström J, Olofsson J, et al. Peripherally inserted central catheter in extremely preterm infants:characteristics and influencing factors[J]. J Neonatal Perinatal Med, 2017, 10(1):63-70.
[26] Goldwasser B, Baia C, Kim M, et al. Non-central peripherally inserted central catheters in neonatal intensive care:complication rates and longevity of catheters relative to tip position[J]. Pediatr Radiol, 2017, 47(12):1676-1681.
[27] Callejas A, Osiovich H, Ting JY. Use of peripherally inserted central catheters (PICC) via scalp veins in neonates[J]. J Matern Fetal Neonatal Med, 2016, 29(21):3434-3438.
[28] Ma M, Garingo A, Jensen AR, et al. Complication risks associated with lower versus upper extremity peripherally inserted central venous catheters in neonates with gastroschisis[J]. J Pediatr Surg, 2015, 50(4):556-558.
[29] Srinivasan HB, Tjin-A-Tam A, Galang R, et al. Migration patterns of peripherally inserted central venous catheters at 24 hours postinsertion in neonates[J]. Am J Perinatol, 2013, 30(10):871-874.
[30] Wrightson DD. Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites[J]. Adv Neonatal Care, 2013, 13(3):198-204.
[31] Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates[J]. J Perinatol, 2013, 33(4):307-312.
[32] Bulbul A, Okan F, Nuhoglu A. Percutaneously inserted central catheters in the newborns:a center's experience in Turkey[J]. J Matern Fetal Neonatal Med, 2010, 23(6):529-535.
[33] Kisa P, Ting J, Callejas A, et al. Major thrombotic complications with lower limb PICCs in surgical neonates[J]. J Pediatr Surg, 2015, 50(5):786-789.
[34] Ejike JC, Mathur M, Moores DC. Abdominal compartment syndrome:focus on the children[J]. Am Surg, 2011, 77(Suppl 1):S72-S77.
[35] Richter RP, Law MA, Borasino S, et al. Distal superficial femoral vein cannulation for peripherally inserted central catheter placement in infants with cardiac disease[J]. Congenit Heart Dis, 2016, 11(6):733-740.
[36] Milstone AM, Reich NG, Advani S, et al. Catheter dwell time and CLABSIs in neonates with PICCs:a multicenter cohort study[J]. Pediatrics, 2013, 132(6):e1609-e1615.
[37] Uygun I. Peripherally inserted central catheter in neonates:a safe and easy insertion technique[J]. J Pediatr Surg, 2016, 51(1):188-191.
[38] Kleidon TM, Ullman AJ, Gibson V, et al. A pilot randomized controlled trial of novel dressing and securement techniques in 101 pediatric patients[J]. J Vasc Interv Radiol, 2017, 28(11):1548-1556. e1.