METHODS: A structured literature search was performed. Single-arm reports and controlled trials reporting event data were eligible. The primary endpoint was a composite of access-related and overall complications.
RESULTS: Nineteen studies, including 6509 RHC procedures, were eligible. The results were analyzed in two groups. The first group compared central venous access (CVA; n = 2072) with peripheral venous access (PVA; n = 2680) and included only multi-arm studies (n = 12, C/P comparison). In the second group, all studies (n = 19, threeway comparison) were assessed to compare the three individual access ways. The overall complication rate was low at 1.0% (n = 68). The primary endpoint in the C/P comparison occurred significantly less for PVA than for CVA (0.1% vs. 1.2%; p = 0.004). In the threeway comparison, PVA had a significantly lower complication rate than femoral access (0.3% vs. 1.1%; p = 0.04). Jugular access had the numerically highest complication rate (2.0%), but the difference was not significant compared to peripheral (0.3%; p = 0.29) or femoral access (1.1%; p = 0.32).
CONCLUSIONS: This meta-analysis showed that PVA for RHC has a significantly lower complication rate than CVA. There was a low level of certainty and high heterogeneity. This pooled data analysis indicated PVA as the primary venous access for RHC.
目的:本荟萃分析评估了选择性RHC的静脉通路部位的选择是否对手术或临床结果有影响。
方法:进行结构化文献检索。单组报告和报告事件数据的对照试验符合资格。主要终点是通路相关和总体并发症的复合。
结果:包括6,509例RHC程序在内的19项研究合格。对两组结果进行分析。第一组将中心静脉通路(CVA;n=2,072)与外周静脉通路(PVA;n=2,680)进行比较,仅包括多臂研究(n=12,C/P比较)。在第二组中,对所有研究(n=19,三方比较)进行了评估,以比较三种单独的访问方式。总并发症发生率为1.0%(n=68)。在C/P比较中,PVA的主要终点发生率明显低于CVA(0.1%vs.1.2%;p=0.004)。在三方面比较中,PVA的并发症发生率明显低于股骨入路(0.3%vs.1.1%;p=0.04)。颈静脉入路的并发症发生率最高(2.0%),但与外周(0.3%;p=0.29)或股骨入路(1.1%;p=0.32)相比,差异不显着。
结论:这项荟萃分析显示,PVA用于RHC的并发症发生率明显低于CVA。确定性水平低,异质性高。该汇总数据分析表明PVA是RHC的主要静脉通路。