Comparison of thrombosis and infection risks related to different transcatheter access ports: a real-world study based on data from 10,000 patients
不同路径植入输液港相关血栓与感染风险的比较：一项基于万例患者数据的真实世界研究

摘要

目的 基于数据分析不同路径植入完全植入式静脉输液港（TIVAP）相关血栓形成与感染风险的发生率及影响因素，为临床路径选择提供循证依据。方法 通过系统检索多个数据库及相关研究，收集关于颈内静脉、锁骨下静脉及上臂静脉路径植入输液港的观察性研究和临床试验数据，采用Meta分析方法整合并发症发生率，并利用单因素与多因素分析探讨独立危险因素。结果 在血栓风险方面，颈内静脉路径与锁骨下静脉路径的整体血栓发生率无显著差异（P>0.05），但锁骨下静脉路径导管断裂和移位风险显著较高（P<0.05）；上臂静脉路径血栓风险与体表路径相似。感染风险分析表明，三种路径的整体感染率无统计学差异，但颈内静脉路径的导管相关性血流感染率略低。多元回归分析确认高龄、糖尿病、导管异位、肠外营养是血栓与感染的共同独立危险因素。结论 颈内静脉路径在整体安全性方面表现最优，尤其可降低机械性并发症；上臂静脉路径作为特定情况下的有效替代。临床路径选择应结合患者解剖特征、并发症风险及超声引导技术，以实现个体化治疗。

Abstract

Objective To analyze the incidence and influencing factors of thrombosis and infection risks associated with transcatheter access ports (TIVAPs) implanted via different pathways, providing evidence-based support for clinical pathway selection.
Methods Observational and clinical trial data on TIVAP implantation via the internal jugular vein, subclavian vein, and upper arm vein pathways were collected through a systematic search of multiple databases and related studies. Meta-analysis was used to integrate complication rates, and univariate and multivariate analyses were used to explore independent risk factors.
Results Regarding thrombosis risk, there was no significant difference in the overall thrombosis incidence between the internal jugular vein and subclavian vein pathways (P>0.05), but the risk of catheter breakage and displacement was significantly higher via the subclavian vein pathway (P<0.05); the thrombosis risk of the upper arm vein pathway was similar to that of the surface pathway. Infection risk analysis showed no statistically significant difference in overall infection rates among the three pathways, but the catheter-related bloodstream infection rate was slightly lower with the internal jugular vein pathway. Multivariate regression analysis confirmed that advanced age, diabetes, catheter ectopic placement, and parenteral nutrition were common independent risk factors for thrombosis and infection.
Conclusion   The internal jugular vein pathway demonstrated the best overall safety, particularly in reducing mechanical complications; the upper arm vein pathway serves as an effective alternative in specific situations. Clinical pathway selection should consider patient anatomical characteristics, complication risk, and ultrasound-guided techniques to achieve individualized treatment.