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重症监护室患者中心静脉导管相关性血流感染现状及危险因素meta分析

王道新 刘楠 师泽元 丁楠楠 冯椿茜 赵文利

王道新, 刘楠, 师泽元, 丁楠楠, 冯椿茜, 赵文利. 重症监护室患者中心静脉导管相关性血流感染现状及危险因素meta分析[J]. 中华全科医学, 2022, 20(11): 1954-1959. doi: 10.16766/j.cnki.issn.1674-4152.002745
引用本文: 王道新, 刘楠, 师泽元, 丁楠楠, 冯椿茜, 赵文利. 重症监护室患者中心静脉导管相关性血流感染现状及危险因素meta分析[J]. 中华全科医学, 2022, 20(11): 1954-1959. doi: 10.16766/j.cnki.issn.1674-4152.002745
WANG Dao-xin, LIU Nan, SHI Ze-yuan, DING Nan-nan, FENG Chun-qian, ZHAO Wen-li. A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients[J]. Chinese Journal of General Practice, 2022, 20(11): 1954-1959. doi: 10.16766/j.cnki.issn.1674-4152.002745
Citation: WANG Dao-xin, LIU Nan, SHI Ze-yuan, DING Nan-nan, FENG Chun-qian, ZHAO Wen-li. A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients[J]. Chinese Journal of General Practice, 2022, 20(11): 1954-1959. doi: 10.16766/j.cnki.issn.1674-4152.002745

重症监护室患者中心静脉导管相关性血流感染现状及危险因素meta分析

doi: 10.16766/j.cnki.issn.1674-4152.002745
基金项目: 

国家自然科学基金面上项目 81872584

河南省科技攻关项目 212102310683

详细信息
    通讯作者:

    赵文利, E-mail: hhzhaowenli@126.com

  • 中图分类号: R472.1  R619.3

A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients

  • 摘要:   目的  分析ICU患者导管相关性感染的危险因素。  方法  检索PubMed、Web of Science、Cochrane Library、CNKI、万方、CBM、EBSCO等数据库中有关ICU患者中心静脉导管相关性血流感染独立危险因素的相关文章,合并结局指标并使用RevMan 5.3软件进行meta分析。  结果  纳入13篇文献,共12 283例患者,出现感染的人数为773例,感染发生率为6.29%。危险因素共9项,包括导管留置时间≥7 d(OR=5.30,95% CI:3.39~8.27)、合并糖尿病(OR=21.15,95% CI:11.45~39.08)、置管前使用抗生素(OR=6.63,95% CI:5.12~8.58)、高龄(OR=3.01,95% CI:2.74~3.31)、穿刺次数>2次(OR=60.10,95% CI:30.63~117.94)、APACHEⅡ评分较高(OR=16.07,95% CI:8.97~28.77)、股静脉置管(OR=12.41,95% CI:3.82~40.30)、男性(OR=7.93,95% CI:3.69~17.04)、经历过急诊手术(OR=8.12,95% CI:3.43~19.19), 均P<0.05。  结论  导管留置时间≥7 d、患者合并糖尿病、置管前使用抗生素、患者年龄>55岁、置管次数>2次、APACHEⅡ评分较高、选择股静脉为留置部位、男性、经历过急诊手术是ICU患者发生中心导管相关性血流感染的主要危险因素。临床上应重视高危人群和相关危险因素,采取有效的干预措施,减少中心静脉导管相关性血流感染的发生。

     

  • 图  1  文献筛选流程图及结果

    Figure  1.  Literature screening flow chart and results

    图  2  导管相关性血流感染与导管留置时间≥7 d的关系

    Figure  2.  Relationship between catheter-associated bloodstream infection and catheter indwelling time ≥7 days

    图  3  导管相关性血流感染与合并糖尿病的关系

    Figure  3.  Relationship between catheter-associated bloodstream infection and diabetes mellitus

    图  4  导管相关性血流感染与高龄的关系

    Figure  4.  Relationship between catheter-associated bloodstream infection and advanced age

    图  5  导管相关性血流感染与穿刺次数>2次的关系

    Figure  5.  Relationship between catheter-associated bloodstream infection and the number of puncture > 2

    图  6  导管相关性血流感染与置管前使用抗生素的关系

    Figure  6.  Catheter-associated bloodstream infections and the use of antibiotics before catheterization

    图  7  导管相关性血流感染与患者APACHEⅡ评分较高的关系

    Figure  7.  Relationship between catheter-associated bloodstream infection and higher APACHEⅡ score in patients

    图  8  导管相关性血流感染与股静脉置管的关系

    Figure  8.  Relationship between catheter-associated bloodstream infection and femoral vein catheterization

    图  9  导管相关性血流感染与男性的关系

    Figure  9.  Relationship between catheter-associated bloodstream infection and male

    图  10  导管相关性血流感染与患者经历过急诊手术的关系

    Figure  10.  Relationship between catheter-associated bloodstream infection and patients undergoing emergency surgery

    图  11  导管留置时间漏斗图

    Figure  11.  Funnel diagram of catheter indwelling time

    表  1  13篇纳入文献基本特征及质量评价

    Table  1.   Basic characteristics and quality evaluation of 13 included literatures

    序号 纳入文献 国家 感染例数 总例数 研究类型 危险因素
    1 廖少玲[5]2016 中国 18 393 队列研究,回顾性分析 A、B
    2 杨波[6]2016 中国 37 358 队列研究,回顾性分析 A、B、C、D
    3 鲍珍[7]2020 中国 98 640 队列研究,回顾性分析 A、B、D、F、G
    4 陶真[8]2017 中国 17 483 队列研究,回顾性分析 A、F
    5 何清[9]2017 中国 31 610 队列研究,回顾性分析 A、C
    6 张细江[10]2012 中国 60 623 队列研究 D、E、F
    7 乔莉[11]2020 中国 28 674 队列研究,回顾性分析 A、F
    8 WU S H[12]2017 中国 38 477 队列研究,回顾性分析 A、H、I
    9 CHENG S Q[13]2019 中国 57 1 523 队列研究 A、B、E、G
    10 LISSAUER M E[14]2012 韩国 58 746 队列研究,回顾性分析 B、C
    11 HAJJEJ Z[15]2014 日本 32 260 前瞻性队列研究 B、F
    12 ALONSO-ECHANOVE J[16]2003 美国 240 4 535 前瞻性队列研究 C、F
    13 ESTEVE F[17]2011 美国 59 961 队列研究,回顾性分析 H、I
    注:危险因素中A为导管留置时间;B为合并糖尿病;C为年龄;D为穿刺次数;E为留置部位;F为抗生素使用;G为APACHEⅡ评分(急性生理与慢性健康评估);H为男性;I为急诊手术。
    下载: 导出CSV

    表  2  纳入文献的质量评价(分)

    Table  2.   Quality evaluation of the included literatures (scores)

    纳入研究 选择的研究人群 可比性 暴露 无应答率 NOS评分
    病例恰当 代表性 对照选择 对照定义 病例 对照 暴露的确定 病例和对照的调查方法
    张细江[10]2012 1 1 1 1 1 0 1 1 0 7
    陶真[8]2017 1 1 1 1 0 1 1 1 0 7
    廖少玲[5]2016 1 1 1 1 1 1 1 1 0 8
    杨波[6]2016 1 1 1 1 1 0 1 0 1 7
    何清[9]2017 1 1 1 1 1 0 1 1 0 7
    鲍珍[7]2020 1 1 1 1 1 0 1 1 0 7
    乔莉[11]2020 1 1 1 1 0 1 1 1 1 8
    ALONSO-ECHANOVE J[16]2003 1 1 1 1 0 1 1 1 0 7
    ESTEVE F[17]2011 1 1 1 1 0 1 1 0 1 7
    HAJJEJ Z[15]2014 1 1 1 1 1 0 1 1 1 8
    WU S H[12]2017 1 1 1 1 0 1 1 1 0 7
    CHENG S Q[13]2019 1 1 1 1 1 0 1 0 0 6
    LISSAUER M E[14]2012 1 1 1 1 1 1 1 1 1 9
    下载: 导出CSV

    表  3  ICU内CRBSI危险因素的meta分析结果

    Table  3.   Meta-analysis results of CRBSI risk factors in ICU

    危险因素 文献数量 统计方法 合并OR 95% CI P I2值(%)
    导管留置时间≥7 d 8 固定效应模型 5.30 3.39,8.27 0.90 0
    合并糖尿病 6 固定效应模型 21.15 11.45, 39.08 0.42 0
    置管前使用抗生素 5 随机效应模型 6.63 5.12,8.58 <0.01 95
    高龄 4 随机效应模型 3.01 2.74,3.31 <0.01 96
    穿刺次数>2次 3 固定效应模型 60.10 30.63,117.94 0.35 5
    APACHEⅡ评分较高 3 随机效应模型 16.07 8.97,28.77 0.02 76
    股静脉置管 2 随机效应模型 12.41 3.82,40.30 0.08 68
    男性 2 固定效应模型 7.93 3.69,17.04 0.58 0
    经历过急诊手术 2 随机效应模型 8.12 3.43, 19.19 0.19 40
    下载: 导出CSV

    表  4  2种模型对ICU患者CRBSI危险因素的敏感性分析

    Table  4.   Sensitivity analysis of the two models to CRBSI risk factors in ICU patients

    危险因素 随机效应模型合并
    OR值(95% CI)
    固定效应模型合并
    OR值(95% CI)
    患者合并糖尿病 21.15(11.45, 39.08) 21.15(11.45,39.08)
    穿刺次数>2次 58.30(31.24, 108.82) 60.10(30.63,117.94)
    男性 7.93(3.69,17.04) 7.93(3.69,17.04)
    下载: 导出CSV
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  • 收稿日期:  2022-03-09
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