本文選題：腫瘤 + 植入式靜脈輸液港�。� 參考：《中國全科醫(yī)學(xué)》2017年26期

【摘要】：目的通過Meta分析的方法探討腫瘤患者應(yīng)用植入式靜脈輸液港(VAP)與經(jīng)外周靜脈穿刺中心靜脈置管(PICC)血栓發(fā)生風(fēng)險(xiǎn)的情況。方法計(jì)算機(jī)檢索中國生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)(CBM)、中國知網(wǎng)(CNKI)、萬方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、維普網(wǎng)(VIP)、Cochrane Library、PubMed、EMBase數(shù)據(jù)庫中關(guān)于VAP(對照組)與PICC(PICC組)治療腫瘤患者血栓發(fā)生率的隨機(jī)對照試驗(yàn)、隊(duì)列研究。檢索時(shí)間從建庫至2016年7月。進(jìn)行資料提取及質(zhì)量評價(jià),采用Stata 12.0軟件對數(shù)據(jù)進(jìn)行Meta分析。結(jié)果共納入4項(xiàng)隨機(jī)對照試驗(yàn)、17項(xiàng)隊(duì)列研究,共4 095例患者。Meta分析結(jié)果顯示,PICC組血栓發(fā)生率高于對照組[RR=2.88,95%CI(1.92,4.33)]。根據(jù)PICC人員分為醫(yī)生置管、護(hù)士參與置管、未報(bào)道3個(gè)亞組,Meta分析結(jié)果顯示,當(dāng)護(hù)士參與置管時(shí),PICC組與對照組腫瘤患者血栓發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義[RR=1.90,95%CI(0.93,3.89)]。醫(yī)生置管、未報(bào)道兩亞組,PICC組血栓發(fā)生率高于對照組[RR=3.06,95%CI(1.13,8.26);RR=3.83,95%CI(2.14,6.88)]。其他亞組分析顯示,患者類型為住院患者、住院和出院患者,患者平均年齡≥18歲、18歲,PICC方式為未報(bào)道、盲穿或超聲引導(dǎo)、超聲引導(dǎo),是否報(bào)道血栓診斷方法,研究類型為隊(duì)列研究,不同發(fā)表國家PICC組血栓發(fā)生率均高于對照組。Begg秩相關(guān)法和Egger's直線回歸法提示研究間無發(fā)表偏倚。結(jié)論與PICC比較,腫瘤患者采用VAP可以降低血栓的發(fā)生風(fēng)險(xiǎn);由護(hù)士參與置管可以降低PICC血栓發(fā)生率;但是在臨床應(yīng)用中,腫瘤患者是否選擇PICC還需要綜合考慮其利弊。
[Abstract]:Objective to investigate the risk of thrombus in patients with tumor by means of meta-analysis with implanted venous infusion port (VAP) and central venous catheterization (PICC) via peripheral venous puncture. Methods A randomized controlled trial was conducted to search the database of China Biomedical document Service system (CBM), China knowledge Network (CNKI), Wanfang data knowledge Service platform and VIP Cochrane Library PubMedemBase database on the incidence of thrombus in patients with tumor treated by VAP (control group) and PICC (PICC group). Cohort study. The retrieval time was from the construction of the database to July 2016. The data were extracted and evaluated. Stata 12.0 software was used to analyze the data. Results A total of 17 cohort studies were conducted in 4 randomized controlled trials. The results of meta analysis showed that the incidence of thrombus in PICC group was higher than that in control group [RRN 2.88% 95 CI (1.92 鹵4.33)]. The results of meta-analysis showed that there was no significant difference in the incidence of thrombus between the PICC group and the control group (RRR1.90 95 CI (0.93 鹵3.89). The incidence of thrombus in PICC group was higher than that in control group. Other subgroup analysis showed that the patient types were inpatients, inpatients and discharged patients. The average age of the patients 鈮，

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