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目的比较血液净化治疗患者肾功能不全时导管常用封管液枸橼酸及肝素效果。方法检索2005—2015年Pub Med、EMBASE、Medline、OVID、Web of Science等数据库中关于肾功能不全患者留置血液净化导管封管时常用封管液枸橼酸和肝素作对比研究的文献。结果共纳入9项研究,1 629例血液净化患者,其中枸橼酸组患者835例,肝素组患者794例。Meta分析显示,导管相关性血流感染(CRB)人数枸橼酸组小于肝素组[=0.34,95%(0.25~0.46),<0.05],两组死亡人数差异无统计学意义[=0.84,95%(0.58~1.21),=0.34],两组尿激酶应用人数差异无统计学意义[=1.01,95%(0.53~1.91),=0.98],因并发症移除导管人数枸橼酸组小于肝素组[=0.45,95%(0.29~0.69),<0.05]。GRADE pro证据评价评分显示,CRB人数为高质量,死亡人数为中等质量,尿激酶应用人数为中等质量,移除导管人数为低质量。结论肾功能不全患者血液净化导管封管时枸橼酸优于肝素。
Objective To compare the effects of citric acid and heparin on the commonly used catheters in patients with renal insufficiency during blood purification. METHODS: A literature review was conducted on PubMed, EMBASE, Medline, OVID, Web of Science and other databases from 2005 to 2015 for citric acid and heparin, a commonly used pipe-sealing fluid for the closure of blood-purging catheters in patients with renal insufficiency. Results A total of 9 studies were included, of which 1 629 blood purification patients were included, including 835 citrate patients and 794 heparin patients. Meta-analysis showed that the number of CRB in citrate group was smaller than that in heparin group [= 0.34, 95% (0.25-0.46), <0.05], and there was no significant difference in the number of deaths between the two groups [= 0.84, (0.58 ~ 1.21), = 0.34]. There was no significant difference in the number of urokinase between the two groups [= 1.01,95% (0.53 ~ 1.91), = 0.98] Less than heparin group [= 0.45, 95% (0.29 ~ 0.69), <0.05]. GRADE pro evidence evaluation scores showed high CRB numbers, medium quality deaths, medium quality urokinase and low quality catheters. Conclusion Citric acid is superior to heparin in the tube of blood purification catheter in patients with renal insufficiency.