刘玉婷　单媛媛　邓雨欣　陈雨　黄家丽

Effect of ball holding exercise on the prevention of catheter－related complications in patients with PICC catheterized tumor：a network Meta－analysis

LIU Yuting，SHAN Yuanyuan，DENG Yuxin，CHEN Yu，HUANG JialiSchool of Nursing，Anhui University of Chinese Medicine，Anhui 230012 ChinaCorresponding Author HUANG Jiali，E－mail：2573114749@qq.com

Abstract Objective：To compare the clinical effects of 5 different degrees of ball holding exercises on axillary vein blood flow and upper limb venous thrombosis in tumor patients with PICC catheterization by network Meta－analysis.Methods：PubMed，Web of Science，the Cochrane Library，EMbase，CNKI，WanFang Database，VIP database and CBM were searched，and the references of the included literatures were tracked.The search deadline was from database establishment to February 2023.RevMan 5.4 software and Stata 16 were used for statistical analysis.Results：6 articles were included，including 5 randomized controlled trials and 1 self－controlled before and after trial，involving 620 patients and 5 different exercise interventions.The maximum grip strength of ≥5 s per time had the best effect on increasing the axillary vein blood flow velocity，and the partial grip strength of ≥5 s per time had the best effect on reducing the incidence of upper limb venous thrombosis.Conclusion：The available evidence suggests that the intervention measures of more than 5 s per grip are recommended，and the dynamic adjustment of each grip strength is combined with different outcome indicators and the patient′s own situation.

Keywords ball holding exercise;peripherally inserted central catheter，PICC;tumor patients;network Meta－analysis;evidence－based nursing

摘要 目的：通過网状Meta分析比较5种不同程度握球运动对PICC置管的肿瘤病人在腋静脉血液流速和上肢静脉血栓发生率2方面的临床效果。方法：检索PubMed、Web of Science、the Cochrane Library、EMbase、中国知网（CNKI）、万方数据库、维普数据库、中国生物医学文献数据库，并追踪纳入文献的参考文献。检索时限为建库至2023年2月。采用RevMan 5.4软件和Stata 16进行统计学分析。结果：最终纳入6篇文献，包括5篇随机对照试验和1篇自身前后对照试验，涉及620例病人、5种不同运动干预措施，其中最大握力维持≥5 s对增加腋静脉血流速度效果最佳，部分握力维持≥5 s对降低上肢静脉血栓发生率效果最佳。结论：现有证据表明，推荐采用每次握球维持5 s以上的干预措施，再结合不同结局指标和病人自身情况对每次握球力度进行动态调整。

关键词 握球运动；PICC；肿瘤病人；网状Meta分析；循证护理

doi：10.12102/j.issn.2095－8668.2024.02.002

据美国癌症研究协会（AACR）预测，截至2040年全球癌症病人总例数将达2 400万人［1］。对癌症病人进行化疗是当下最主要的治疗方式之一，因化疗药物对血管壁刺激性强，而经外周静脉穿刺置入中心静脉导管（peripherally inserted central catheter，PICC）有费用低、留置时间长等优点［2］，故被广泛应用于肿瘤病人的治疗中［3］。有研究表明，PICC导管仍会存在感染［4］、移位、静脉血栓［5］等并发症。临床上，护理人员

结合《输液治疗实践标准》［6］给予PICC置管肿瘤病人上肢抗阻运动锻炼指导，主要包括握球/握拳运动、旋腕运动、手臂操等［7］，其中握球运动不仅操作简单，且能改善上肢静脉血液流速、有效降低并发症发生率［8］，因而被广泛采用。……