血液透析患者中心静脉置管抗生素与肝素封管预防导管相关感染效果比较的Meta分析

    Comparison of prophylaxis effects against catheter -associated infection between antibiotic and heparin sealing-up way in central venous catheterization: a meta-analysis

      摘要
    • 摘要: 目的 系统评价血液透析患者中心静脉置管抗生素与肝素封管预防导管相关感染的临床效果。方法 检索MEDLINE、PubMed、The Cochrane Library、CBM、CNKI、万方等数据库，搜集比较抗生素封管和肝素封管效果的随机对照试验，通过2位研究者独立筛选文献，采用RevMan 5.3软件进行统计分析。结果 共纳入40篇随机对照试验文献，其中31篇英文文献，9篇中文文献。Meta分析结果显示，抗生素组导管相关感染发生率低于肝素组，差异具有统计学意义OR=0.34，95%CI（0.30~0.38），I2=39%，P<0.01。亚组分析显示，抗生素组置管出口感染率低于肝素组，但差异不具有统计学意义OR=0.83，95%CI（0.67~1.02），I2=0%，P=0.07；抗生素组患者365日无导管感染存活率高于肝素组，差异有统计学意义OR=-5.43，95%CI（3.53~8.35），I2=0%，P<0.01；抗生素组导管留置时间长于肝素组，差异具有统计学意义SMD=1.04，95%CI（0.27~1.82），I2=100%，P<0.01；抗生素组导管内血栓发生率低于肝素组，差异具有统计学意义OR=0.65，95%CI（0.46~0.90），I2=32%，P<0.05；抗生素组导管感染死亡率低于肝素组，差异具有统计学意义OR=0.53，95%CI（0.38~0.74），I2=42%，P<0.01。结论 本研究结果表明，中心静脉置管的患者使用抗生素封管预防导管相关感染的效果优于纯肝素封管，但尚需对使用抗生素的可行性做进一步的探讨。

       

      Abstract: Objective To evaluate systematically the clinical effect of antibiotic and heparinsealing-up ways was in central venous catheterization injection for prevention against catheter-associated infection in patients with hemodialysis. Methods Computer retrieval in MEDLINE, PubMed, The Cochrane Library, CBM, CNKI, Wanfang and other databases were performed. Randomized controlled trials (RCTs) of the effect of antibiotic and heparin sealing-up ways were collected. Two researchers screened the literature independently and used software Rev Man 5.3 for statistical analysis. Results There were 40 articles of RCTs in total, including 31 English ones and 9 Chinese ones. The results of meta-analysis showed that the infection rate of the antibiotic group was lower than that of the heparin group, with difference of statistical significanceOR=0.34,95%CI(0.30-0.38), I2=39%,P<0.01. Subgroup analysis showed that the rate of catheter exit infection in the antibiotic group was lower than that in the heparin group, with statistically significant differenceOR=0.83,95%CI(0.67-1.02),I2=0%,P=0.07. The 365-day survival rate without catheter-associated infection in the antibiotic group was higher than that in the heparin group, with statistically significant differenceOR=-5.43,95%CI(3.53-8.35),I2=0%,P<0.01. The catheter-indwelling time in the antibiotic group was longer than that in the heparin group, with statistically significant differenceSMD=1.04,95%CI(0.27-1.82),I2=100%,P<0.01. The incidence of thrombus in the antibiotic group was lower than that in the heparin group, with statistically significant differenceOR=0.65,95%CI(0.46-0.90),I2=32%,P<0.05. The mortality rate of the antibiotic group was lower than that of the heparin group, with statistically significant differenceOR=0.53,95%CI(0.38-0.74),I2=42%,P<0.01.Conclusions This results from this study show, for patients with hemodialysis through the vascular access of central venous catheterization, the use of antibiotic sealing-up way to prevent against catheter-associated infectionhas better effect than the pure Heparin sealing-up way, but the feasibility of antibiotics needs to be further discussed.

       

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