中国血液净化

›› 2011, Vol. 10 ›› Issue (02): 67-70.doi: 10.3969/j.issn.1671-4091.2011..00

• 临床研究 • 上一篇    下一篇

血液透析患者中心静脉导管纯肝素封管可行性的系统评价

崔文鹏 杜 冰 周文华 徐 锋 许钟镐 苗里宁   

  1. 吉林大学第二医院肾内科
  • 收稿日期:2010-08-25 修回日期:1900-01-01 出版日期:2011-02-12 发布日期:2011-02-12
  • 通讯作者: 苗里宁

Meta analysis on feasibility of sealing central venous catheter using pure heparin in hemodialysis patients

CUI Wen-peng, DU Bing, ZHOU Wen-hua, XU Feng, XU Zhong-gao, MIAO Li-ning   

  1. 1Department of Nephrology, the Second Hospital of Jilin University, Changchun 130041, China; 2Department of Cardiology, the First Hospital of Jilin University, Changchun 130031, China
  • Received:2010-08-25 Revised:1900-01-01 Online:2011-02-12 Published:2011-02-12

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摘要： 目的 系统评价血液透析患者中心静脉导管纯肝素封管的可行性。 方法 计算机检索Cochrane图书馆临床对照试验资料库、MEDLINE、中国知网、万方数据库，并用RevMan 4.2软件对相关研究进行meta分析。 结果 最终纳入5篇文献共516例患者进行系统评价，纳入文献均为C级。Meta分析结果显示，观察组中心静脉导管留置时间明显长于对照组[WMD=14.31,95%CI(8.67～19.96),Z=4.97,P＜0.01]，血栓发生率明显低于对照组[OR=0.29,95%CI(0.17～0.51),Z =4.41,P＜0.01]，感染发生率亦明显低于对照组[OR=0.21,95%CI(0.10～0.45),Z=4.11,P＜0.01]；渗血率与对照组差异无统计学意义[OR=0.80,95%CI(0.32～2.01),Z=0.47,P=0.64]。漏斗图散点分布近似左右对称，提示纳入研究不存在发表偏倚。 结论 现有的研究结果表明，应用纯肝素封管，可以有效降低血栓发生率、感染率，延长导管留置时间，不增加出血风险。

关键词: 肝素, 中心静脉导管, 血液透析, 系统评价, Meta分析

Abstract: Objective To assess the feasibility of sealing central venous catheter using pure heparin in hemodialysis patients. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2010), MEDLINE (1995 to August, 2010), CNKI (1995 to August, 2010) and WanFang databases (1995 to August, 2010) for this issue. We also manually searched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which pure heparin was used to treat central venous catheter in hemodialysis patients were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta analyses by using RevMan 4.2 software. Results A total of 98 articles were found, and 5 articles with 516 patients were finally included. All of these articles were regarded as grade C. We chose fixed-effect model to make meta analysis because no heterogeneity was found among the RCTs studying the rates of thrombosis, infection and bleeding; while random-effect model was used to make meta analysis because significant heterogeneity was found among the RCTs studying catheter retention time. The results of meta analysis confessed that there were significant increase in catheter retention time [WMD=14.31, 95%CI (8.67~19.96), P＜0.00001], and significant decrease in thrombosis rate [OR=0.29, 95%CI (0.17~0.51), P＜0.0001] and infection rate [OR=0.21, 95%CI (0.10~0.45), P＜0.0001] in observation group compared with control group. While the bleeding rate [OR=0.80, 95%CI (0.32~2.01), P=0.64] in observation group was similar to that in control group. Funnel-plot displayed a symmetrical figure, indicating no publication bias. Conclusion The evidence currently available showed that sealing central venous catheter in hemodialysis patients with pure heparin may decrease the thrombosis rate and infection rate, and increase the catheter retention time, without increasing bleeding risk. However, as the insufficient quality and quantity of the present data, more articles with high quality are needed to obtain more rigorous and objective clinical evidences.

Key words: Central venous catheter, Hemodialysis, Systemic review, Meta analysis