颈内静脉置管与锁骨下静脉置管常见并发症的Meta分析

Meta-analysis on common complications of internal jugular vein catheterization and subclavian vein catheterization

摘要:

目的 探讨颈内静脉(IJV)与锁骨下静脉(SCV)置管常见并发症的发生风险,以期为临床静脉输液治疗过程常见并发症的防治提供参考。方法 检索中国知网(CNKI)、万方数据库、维普数据库、Embase(via OVID)、PubMed、Cochrane Library、CINAHL、Web of Science、ScienceDirect数据库,检索日期为建库至2023年8月3日。收集IJV与SCV置管患者常见并发症的前瞻性队列研究和试验性研究,应用RevMan 5.3软件对提取数据进行Meta分析。结果 共纳入29项研究,14 096例患者,其中SCV置管(SCV组)患者6 355例,IJV置管(IJV组)患者7 741例。Meta分析结果显示,SCV组患者血气胸［OR=0.23,95%CI(0.14~0.37)］、导管尖端异位［OR=0.16,95%CI(0.03~0.85)］发生风险均较IJV组高,中心静脉导管相关深静脉血栓发生风险IJV组患者较SCV组高［OR=2.35,95%CI(1.31~4.21)］,差异均具有统计学意义(均P＜0.01)。血管导管相关血流感染(CRBSI)、导管堵塞、导管局部血肿发生风险两组比较,差异均无统计学意义(均P＞0.05),导管细菌定植在亚组分析的合并结果中存在差异。结论 较IJV,SCV患者发生血气胸、导管尖端异位的风险更高,而IJV置管患者深静脉血栓风险更高,两组患者在CRBSI、导管堵管、导管局部血肿发生风险方面均无明显差异,建议临床在选择深静脉置管部位时,更多考虑患者自身情况及深静脉置管操作的可及性。

Abstract:

Objective To investigate the occurrence risk for common complications of internal jugular vein (IJV) and subclavian vein (SCV) catheterization, and provide reference for the prevention and treatment of common complications during clinical intravenous infusion therapy. Methods Data from China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, Embase (via OVID), PubMed, Cochrane Library, CINAHL, Web of Science, and ScienceDirect were retrieved, with the search period from database establishment to August 3, 2023. Prospective cohort and experimental studies on common complications in patients with IJV and SCV cathete-rization were collected. Meta-analysis on the extracted data was performed with RevMan 5.3 software. Results A total of 29 studies involving 14 096 patients were included in the analysis, including 6 355 patients with SCV catheterization (SCV group) and 7 741 patients with IJV catheterization (IJV group). Meta-analysis results showed that the occurrence risk for hemopneumothorax (OR=0.23, 95%CI ［0.14-0.37］) and catheter tip ectopic (OR=0.16, 95%CI ［0.03-0.85］) in SCV group was higher than that in IJV group, and the occurrence risk for central venous catheter-related deep venous thrombosis in IJV group was higher than that in SCV group (OR=2.35, 95%CI ［1.31-4.21］), with statistically significant differences (all P<0.01). There were no statistical differences in the occurrence risk of vascular catheter-related bloodstream infection (CRBSI), catheter blockage, and catheter local hematoma between the two groups (all P>0.05), there was difference in the combined result of subgroup analysis regarding catheter bacterial colonization. Conclusion Compared with IJV, patients in SCV group have a higher risk of developing hemopneumothorax and catheter tip ectopic, while patients with catheterization in IJV group have a higher risk of deep veinous thrombosis. There are no significant differences in the occurrence risk for CRBSI, catheter blockage, and catheter local hematoma between two groups of patients. It is suggested that patient’s own conditions and the accessibility of deep vein catheterization should be considered more when selecting the site of deep venous catheterization.