在新生兒週邊置放的經皮式中央靜脈導管“連續肝素輸注”，以防止血栓形成和導管阻塞

BACKGROUND: Complications associated with peripherally placed percutaneous central venous catheters (PCVC) in neonates include catheter thrombosis, occlusion or dislodgement and infection. Strategies to prevent catheter thrombosis and occlusion include the use of heparin. However, heparin is known to be associated with complications such as bleeding and thrombocytopenia. OBJECTIVES: To assess the effectiveness of heparin for prevention of catheter related thrombosis. Secondary objectives included assessment of the effectiveness of heparin on catheter occlusion, duration of catheter patency, catheter related sepsis and complications associated with the use of heparin. SEARCH STRATEGY: A literature search of MEDLINE, EMBASE, CINAHL from their inception to September 13, 2010, The Cochrane Library (Issue 2, 2010) and abstracts from the annual meetings of the Pediatric Academic Societies was performed. SELECTION CRITERIA: Randomized or quasi-randomised clinical trials of neonates where heparin infusion was compared to placebo or no treatment for prevention of any of the complications related to peripherally placed PCVC were included. DATA COLLECTION AND ANALYSIS: We collected and analysed the data in accordance with the recommendations of the Cochrane Neonatal Review Group. MAIN RESULTS: Four randomised trials were identified. Three trials (including 477 infants) of adequate methodology met the eligibility criteria. There was reduced risk of catheter occlusion (typical RR 0.39, 95% CI 0.22 to 0.67; and NNT 9, 95% CI 6 to 20). There was no statistically significant difference in the duration of catheter patency; however, in one study survival analyses identified benefit with heparin (adjusted hazard ratio 0.55, 95% CI 0.36, 0.83). This could be due to higher incidence of elective removal of catheters in neonates at the completion of therapy in the heparin group in that study (63% vs. 42%; p = 0.002). There was no statistically significant differences in the risk of thrombosis (typical RR 0.93, 95% CI 0.58 to 1.51), catheter related sepsis (typical RR 0.82, 95% CI 0.43 to 1.57), or extension of intraventricular haemorrhage (typical RR 0.50, 95% CI 0.19 to 1.28) between the two groups. AUTHORS' CONCLUSIONS: Prophylactic use of heparin for peripherally placed PCVC allows a greater number of infants to complete their intended use (complete therapy) by reducing occlusion. Evidence from this systematic review support the prophylactic use of heparin for PCVC in neonates. None of these studies was powered to evaluate a lower incidence rate of adverse events. If this therapy is adopted in routine practice, monitoring of side effects is indicated.