Zhong Lei, Wang Hai-Li, Xu Bo, Yuan Yao, Wang Xin, Zhang Ying-Ying, Ji Li, Pan Zi-Mu, Hu Zhan-Sheng
Department of Intensive Care Units, The First Affiliated Hospital of Jinzhou Medical University, No. 2, The Fifth Section of Renmin Street, Guta, Jinzhou, 121000, Liaoning, China.
Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, Liaoning, China.
Crit Care. 2017 Jan 8;21(1):5. doi: 10.1186/s13054-016-1585-x.
Heparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.
We searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.
Ten RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).
Based on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.
理论上，肝素盐水（HS）在维持中心静脉导管（CVC）通畅方面优于生理盐水（NS），但其比较疗效仍存在争议。本系统评价和荟萃分析的目的是评估NS与HS在维持成年患者CVC通畅方面的疗效。
我们检索了PubMed、Embase和Cochrane图书馆数据库。纳入评估NS与HS用于维持成年患者CVC通透性的随机对照试验（RCT）进行荟萃分析。手动查阅相关论文的参考文献。不设语言限制。排除非人体研究。采用Mantel-Haenszel随机效应模型计算合并相对风险（RR）。我们还进行了亚组分析，研究导管留置时间对结果的影响。所有统计检验均为双侧检验，显著性水平为0.05。
本荟萃分析纳入了10项RCT，涉及7875名受试者（在患者、导管、管腔和血管通路水平进行分析）。无论是在汇总分析还是局部分析中（RR的95%置信区间跨度为1），NS在保持CVC通畅方面即使不比HS更有效，至少也是同样有效的。在报告次要结局（所需操作、肝素诱导的血小板减少症、出血、中心静脉血栓形成和导管相关血流感染）的研究中，肝素盐水并不优于非肝素溶液。短期与长期留置CVC患者的亚组分析部分与主要结局一致，特别是对于长期留置（即>30天）患者的导管通畅维持，RR为0.97（n = 6589；95%CI = 0.76至1.23；P = 0.796）。然而，对于导管留置时间<30天的患者，RR为1.52（n = 1286；95%CI = 1.02至2.27；P = 0.041）。
基于本荟萃分析的结果，HS在减少CVC堵塞方面并不优于NS。但在短期内，从统计学角度来看，使用HS冲洗导管略优于NS。
