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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (6): 419-425.

• 论著 • 上一篇    下一篇

儿科中心静脉导管相关血栓发生的系统评价和Meta分析

王文超 1a,王颖雯 1b,康琼芳 1a,顾 莺 1a,季福婷 1c,王 瑞 1d,张玉侠 2,张崇凡 1d,   

  1. 1 复旦大学附属儿科医院上 海，201102，a 护理部，b 血液肿瘤科，c 新生儿科，d 临床指南制作和评价中心；2 复旦大学附属中山医院上 海，200032
  • 收稿日期:2020-12-18 修回日期:2020-12-25 出版日期:2020-12-25 发布日期:2020-12-25
  • 通讯作者: 张崇凡；张玉侠

Central venous access device-related thrombosis in pediatric patients：A systematic review and meta-analysis

WANG Wenchao1a, WANG Yingwen1b, KANG Qiongfang1a, GU Ying1a, JI Futing1c, WANG Rui1d, ZHANG Yuxia2, ZHANG Chongfan1d    

  1. 1 Children’s Hospital of Fudan University, Shanghai 201102, China, a. Nursing Department, b. Department of Hematology and Oncology, c. Department of Neonatology, d. Center for Clinical Practice Guideline Development and Evaluation; 2 Zhongshan Hospital of Fudan University, Shanghai 200032, China
  • Received:2020-12-18 Revised:2020-12-25 Online:2020-12-25 Published:2020-12-25
  • Contact: ZHANG Chongfan; ZHANG Yuxia

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摘要： 目的：系统评价儿科中心静脉导管（CVAD）相关血栓发生的保护和危险因素。方法：系统检索英文数据库（Ovid-Medline、Embase、Cochrane Library）和中文数据库（中国知网、中国生物医学文献数据库）建库至2020年11月16日的队列研究和病例对照研究文献，纳入置入CVAD的住院新生儿至青少年人群，排除使用CVAD行肾脏替代治疗的儿科人群，对证据体行GRADE证据评价。结果：纳入13篇队列研究和1篇巢式病例对照研究，2000年以后文献13篇，北美和欧洲10篇；CVAD相关性血栓的诊断均来自静脉造影或静脉超声检查（发生率3.3%~30.3%），3 848根CVAD导管纳入分析，其中经外周静脉置入的中心静脉导管（PICC）538根、非隧道式导管509根、隧道式导管241根、完全植入式静脉输液港583根；颈内静脉置管360根，锁骨下静脉置管354根，股静脉置管162根；219根导管出现导管功能障碍。①CVAD因素中，非隧道式导管OR=0.37(95%CI:0.21~0.63)，股静脉置管OR=1.99（95%CI:1.15~3.44），导管功能障碍OR=2.44（95%CI:1.59~3.76），导管留置时间每增加1d OR=1.01（95%CI:1.00~1.02），差异均有统计学意义；②疾病状态因素中，急性白血病OR=2.96（95%CI:2.02~4.32），差异有统计学意义；③治疗过程：使用门冬酰胺酶OR=3.86（95%CI:1.82~8.20），输入肠外营养OR=1.85（95%CI:1.25~2.75）。GRADE证据评价均为极低质量证据。结论：CVAD相关血栓的发生中，非隧道式导管是保护因素，急性白血病、脓毒症、股静脉置管部位、导管功能障碍、治疗使用肠外营养、导管留置时间长是危险因素。

Abstract: Objective：To systematically evaluate the protection and risk factors of central venous catheter (CVAD)-related thrombosis. Methods：A systematic search was performed in both of English and Chinese databases of Ovid-medline, Embase, Cochrane Library, CNKI and SinoMed for cohort and case-control studies from the time of their establishment to November 16th, 2020. Both of hospitalized neonates and young adults with CVADs were included and the pediatric population who used CVAD for renal replacement therapy was excluded. The quality of evidence body was evaluated by GRADE methodology. Results：Thirteen cohort studies and 1 nested case-control study were included. There were 13 articles published after the year of 2000, including 10 from North America and Europe. CVAD-related thrombosis (CRT) was diagnosed by venography or intravenous ultrasonography (incidence rate 3.3%-30.3 %). A total of 3,848 CVAD catheters were included in the analysis, including 538 PICCs, 509 non-tunnel catheters, 241 tunnel catheters and 583 totally implantable venous access ports. Among them, there were 360 in the internal jugular vein, 354 in the subclavian vein and 162 in the femoral vein. Two hundred and nineteen catheters had catheter dysfunction. CVAD-related factors included non-tunnel catheter (OR=0.37, 95%CI: 0.21-0.63), femoral venous catheterization (OR=1.99, 95% CI: 1.15-3.44), catheter dysfunction (OR=2.44, 95%CI: 1.59-3.76), and every additional day of catheter indwelling time (OR=1.01, 95%CI: 1.00-1.02) with statistically significant difference. Disease state factors included acute leukemia (OR=2.96, 95%CI: 2.02-4.32) and there was statistically significant difference. Factors of treatment process included the usage of asparaginase (OR=3.86, 95%CI: 1.82-8.20) and parenteral nutrition (OR=1.85, 95%CI: 1.25-2.75). The overall quality of evidence was very low. Conclusion：For the occurrence of CRT, non-tunnel catheter is a protection factor and risk factors are acute leukemia, sepsis, femoral venous catheterization, catheter dysfunction, parenteral nutrition in treatment, and long catheter indwelling time.