隧道与皮下延伸穿刺技术在PICC中应用效果的Meta分析

Meta Analysis of the Application Effect of Tunnel and Extended Subcutaneous Route Technique in PICC

摘要: 目的：评价隧道与皮下延伸穿刺技术在经外周静脉置入中心静脉导管(PICC)中的临床应用效果，旨在为患者选择合适的置管技术提供参考依据。方法：检索中国(CNKI)学术文献总库、中文科技期刊数据库(VIP)、Pubmed、Web of Science数据库，全面收集隧道技术、皮下延伸穿刺技术在PICC中应用的相关研究，严格按照制定的文献纳入与排除标准进行文献筛选，并对文献质量进行评估；采用RevMan和R软件对提取的数据进行Meta分析，分别以隧道PICC (tPICC)、皮下延伸穿刺PICC (esrPICC)与常规PICC (cPICC)并发症发生率的危险比OR值为效应指标，评价两种穿刺技术与常规技术比较的临床应用效果。结果：共纳入12篇文献共1106病例(tPICC VS cPICC 9篇，esrPICC VS cPICC 3篇)。Meta分析结果显示，采用tPICC置管的患者并发症发生风险是常规置管者的0.08倍(OR_(合并) = 0.08, 95% CI:0.05~0.12, P < 0.00001)；采用esrPICC置管的患者并发症发生风险是常规置管者的0.14倍(OR_(合并) = 0.14, 95% CI: 0.07~0.26, P < 0.00001)。通过对纳入文献进行合并分析，tPICC术后并发症发生率为7% (95% CI: 0.02~0.15, P < 0.01)，esrPICC术后并发症发生率为21% (95% CI: 0.06~0.36, P < 0.01)。Begg漏斗图检验法显示纳入的文献不存在发表偏倚，结果较为可靠。结论：tPICC、esrPICC分别与cPICC相比，均可显著降低PICC导管相关并发症的发生率，且tPICC的效果优于esrPICC。

Abstract: Objective: To evaluate the clinical application of tunnel and subcutaneous extension puncture technique in the central venous catheter (PICC) placement through peripheral vein, in order to provide a reference for patients to choose the appropriate catheterization technique. Methods: The Chinese (CNKI) Academic Literature Database, Chinese Science and Technology Journal Database (VIP), Pubmed, and Web of Science databases were searched to comprehensively collect studies related to the application of tunneling and subcutaneous extension puncture techniques in PICC, and the literature was screened in strict accordance with the established literature inclusion and exclusion criteria, and the quality of the literature was evaluated; RevMan and R software was used to Meta-analyze the extracted data, and the OR values of hazard ratios of complication rates of tunneled PICC (tPICC) and extended subcutaneous route PICC (esrPICC) compared with conventional PICC (cPICC) were used as effect indicators to evaluate the clinical application of the two puncture techniques compared with conventional PICC puncture techniques, respectively. Results: A total of 12 papers with 1106 cases (tPICC vs. cPICC 9, esrPICC vs. cPICC 3) were included. Meta-analysis showed that the risk of complications was 0.08 times higher in patients with tPICC technique placement than in those with conventional placement (OR_(combined) = 0.08, 95% CI: 0.05~0.12, P < 0.00001); patients with the risk of complications was 0.14 times higher in patients with esrPICC technique placement than in those with conventional placement (OR_(combined) = 0.14, 95% CI: 0.07~0.26, P < 0.00001). By combined analysis of the included literature, the complication rate was 7% (95% CI: 0.02~0.15, P < 0.01) for tPICC and 21% (95% CI: 0.06~0.36, P < 0.01) for esrPICC. Begg’s funnel plot test showed no publication bias in the included literature and the results were more reliable. Conclusions: tPICC and esrPICC significantly reduced the incidence of PICC catheter-related complications compared with cPICC, respectively, and tPICC was more effective than esrPICC.