肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析

doi:10.16460/j.issn1008-9969.2019.11.049

摘要/Abstract

摘要： 目的通过Meta分析明确肿瘤患者PICC置管相关静脉血栓形成的危险因素,为预防及降低肿瘤患者PICC置管相关静脉血栓形成提供参考依据。方法在中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库、维普数据库、百度文库、PubMed、EMbase、Web of Science、Medline、Cochrane中进行文献检索,检索时间为开始收录时间起到2018年11月并进行文献质量评价,应用Stata 13.0对国内外有关肿瘤患者PICC置管相关静脉血栓形成危险因素的病例对照研究及队列研究进行Meta分析,用 Egger线性回归法判定发表偏倚。结果共纳入18篇文献,总病例6 425例,病例组/暴露组825例,对照组/非病例组5 600例。危险因素合并OR 值分别为：年龄≥60岁2.560（95%CI：1.653~3.967）、超重或肥胖3.552（95%CI：2.103~5.998）、合并高血压2.041（95%CI：1.302~3.200）、合并糖尿病2.021（95%CI：1.695~2.409）、PICC置管史2.188（95%CI：1.204~3.976）、置管期间放疗4.308（95%CI：1.901~9.763）、活动量少4.559（95%CI：1.035~20.085）、感染2.748（95%CI：1.397~5.408）、肿瘤分期为Ⅲ~Ⅳ期2.746（95%CI：1.643~4.589）、肿瘤转移4.023（95%CI：1.895~8.544）。Egger线性回归法分析显示,活动量少、肿瘤转移、置管期间放疗存在一定发表偏倚。结论年龄≥60岁、超重或肥胖、合并高血压、合并糖尿病、PICC置管史、感染、肿瘤分期为Ⅲ~Ⅳ期为肿瘤患者PICC置管相关静脉血栓形成的危险因素,活动量少、肿瘤转移、置管期间放疗作为肿瘤患者PICC置管相关静脉血栓的危险因素的证据尚不充分。应对肿瘤患者中存在的可改变危险因素进行早期干预,加强监测不可改变危险因素。

关键词: 肿瘤, PICC, 静脉血栓, 危险因素, Meta分析

Abstract: Objective To identify the risk factors of PICC-related venous thrombosis in cancer patients through meta analysis and provide reference for the prevention and reduce of PICC-related venous thrombosis. Methods We retrieved CNKI, CBM, Wangfang Datbase, VIP, Baidu Library, PubMed, Embase, Web of Science, Medline, Cochrane from the inception to November 2018 to collect case-control studies and cohort studies on risk factors of PICC-related venous thrombosis in cancer patients. Meta analysis was performed by using Stata 13.0 and the Egger's linear regression to test publication bias. Results There were 18 included articles of 6, 425 patients, 825 in case group/exposed group and 5, 600 in control group/non-case group. Risk factors and OR value were as follows: aged over 60, 2.560 (95%CI：1.653~3.967); overweight or obesity, 3.552 (95%CI：2.103~5.998), combined with hypertension, 2.041 (95%CI：1.302~3.200), combined with diabetes, 2.021 (95%CI：1.695~2.409 ), a history of PICC, 2.188 (95%CI：1.204~3.976), having radiotherapy with PICC, 4.308 (95%CI：1.901~9.763), inadequate activity, 4.559 (95%CI：1.035~20.085), infection, 2.748 (95%CI：1.397~5.408), TNM stage III to IV 2.746 (95%CI：1.643~4.589) and tumor metastasis, 4.023 (95%CI：1.895~8.544). Egger's linear regression showed that publication bias was found pertaining to inadequate activity, tumor metastasis and having radiotherapy with PICC. Conclusion Risk factors of PICC-related venous thrombosis in cancer patients include aged over 60, overweight or obesity, combined with hypertension or diabetes, a history of PICC, infection and TNM stage III to IV but there are not adequate evidences for risk factors such as inadequate activity, tumor metastasis and having radiotherapy with PICC. Early intervention should be performed for changeable risk factors and more monitoring for unchangeable ones.

Key words: cancer, PICC, venous thrombosis, risk factor, Meta analysis

中图分类号:

R472.9

田婷, 黄锐娜, 戚熠, 周亚娟, 韩慧, 刘婉君, 贺海霞, 吴小婉. 肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析[J]. 护理学报, 2019, 26(11): 49-54.

TIAN Ting, HUANG Rui-na, QI Yi, ZHOU Ya-juan, HAN Hui, LIU Wan-jun, HE Hai-xia, WU Xiao-wan. Risk Factors of PICC-related Venous Thrombosis in Cancer Patients: A Meta-analysis[J]. Journal of Nursing, 2019, 26(11): 49-54.

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