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

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。方法计算机检索相关数据库,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。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0R=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0R=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。

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

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 timeWMD=14.31,95%CI（8.67～19.96）,P0. 00001],and significant decrease in thrombosis rateOR=0.29,95%CI（0.17～0.51）,P0.0001]and infection rate OR=0.21,95%CI（0.10～0.45）,P0.0001]in observation group compared with control group.While the bleeding rateOR=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.