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...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 (合并) = 0.14, 95% CI: 0.07~0.26, P 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 (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.展开更多
经外周置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)临床应用广泛,经历了盲法穿刺、超声引导穿刺、腔内心电图定位等几个发展阶段,大大提高了穿刺成功率和置管成功率,显著降低了导管相关性并发症。但是导管留置期间...经外周置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)临床应用广泛,经历了盲法穿刺、超声引导穿刺、腔内心电图定位等几个发展阶段,大大提高了穿刺成功率和置管成功率,显著降低了导管相关性并发症。但是导管留置期间并发症仍不可忽视。隧道式PICC是通过皮下隧道将PICC出口位点与穿刺位点远离的技术,可以降低静脉血栓和感染发生率、导管移位率、出血。另外,对于创伤、烧伤、瘢痕等导致皮肤受损,易感染或不易观察穿刺点周围组织的患者,出口位置选择性更多。隧道PICC是一种应用前景广阔的PICC置管新技术。展开更多
文摘目的: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 (合并) = 0.14, 95% CI: 0.07~0.26, P 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 (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.
文摘经外周置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)临床应用广泛,经历了盲法穿刺、超声引导穿刺、腔内心电图定位等几个发展阶段,大大提高了穿刺成功率和置管成功率,显著降低了导管相关性并发症。但是导管留置期间并发症仍不可忽视。隧道式PICC是通过皮下隧道将PICC出口位点与穿刺位点远离的技术,可以降低静脉血栓和感染发生率、导管移位率、出血。另外,对于创伤、烧伤、瘢痕等导致皮肤受损,易感染或不易观察穿刺点周围组织的患者,出口位置选择性更多。隧道PICC是一种应用前景广阔的PICC置管新技术。
