不同持续时间俯卧位通气对急性呼吸窘迫综合征患者疗效的影响——一项小型Meta分析

Effect of different durations of prone ventilation on the efficacy of patients with acute respiratory distress syndrome:a small Meta-analysis

目的系统评价不同持续时间俯卧位通气对急性呼吸窘迫综合征(ARDS)患者治疗效果的影响。方法计算机检索美国国立医学图书馆PubMed、Cochrane Library、荷兰医学文摘Embase、中国知网、万方数据库、维普数据库、中国生物医学文献数据库等,从建库至2023年9月发表的关于俯卧位通气治疗成人ARDS患者的研究,根据每次俯卧位通气持续时间分为≤24 h组和>24 h组。结局指标包括:病死率、重症监护病房(ICU)住院时间、压疮发生率及气管切开术操作。由2名研究员独立筛选文献、提取资料,评价纳入文献的偏倚风险。采用NOS量表对纳入的文献进行质量评估,Meta分析不同持续时间俯卧位通气对ARDS疗效的影响。结果最终纳入4篇文献共517例患者,其中俯卧位通气持续时间≤24 h者249例,>24 h者268例。4项研究均为队列研究,总体纳入文献经方法学质量评估后表明研究质量较高,存在偏倚风险性较低。Meta分析结果显示,俯卧位通气持续时间≤24 h组与>24 h组之间ARDS患者的病死率〔相对危险度(RR)=1.02,95%可信区间(95%CI)为0.79~1.31,P=0.88〕、ICU住院时间〔均数差(MD)=-2.68,95%CI为-5.30~-0.05,P=0.05〕差异无统计学意义。与俯卧位通气持续时间≤24 h组相比,俯卧位通气持续时间>24 h组ARDS患者的压疮发生率(RR=0.76,95%CI为0.59~0.98,P=0.04)及气管切开术操作(RR=0.71,95%CI为0.53~0.94,P=0.02)显著增加。结论俯卧位通气持续时间对ARDS患者病死率和ICU住院时间无明显影响,但俯卧位通气时间>24 h会增加压疮发生率及气管切开术操作,由于纳入研究数量少,该结论仍需大量研究进一步验证。

Objective To systematically evaluate the effect of different durations of prone ventilation on the efficacy of patients with acute respiratory distress syndrome(ARDS).Methods A computer search was conducted in databases including PubMed,Cochrane Library,Embase,CNKI,Wanfang Database,VIP Database,and China Biomedical Literature Database for studies on prone ventilation for the treatment of adult patients with ARDS published from the establishment of the database to September 2023.Studies were categorized into≤24 hours group and>24 hours group based on the duration of prone ventilation.Outcome indicators included mortality,the length of intensive care unit(ICU)stay,incidence of pressure ulcers,and operation of tracheotomy.Two researchers independently screened the literature,extracted information,and evaluated the risk of bias of the included literature.The quality of the included literature was assessed using the NOS scale,and the effect of different durations of prone ventilation on the efficacy of ARDS was analyzed by Meta-analysis.Results A total of 517 patients from 4 papers were finally included,including 249 patients with prone ventilation duration≤24 hours and 268 patients with prone ventilation duration>24 hours.All 4 studies were cohort studies,and the overall inclusion of literature assessed for methodological quality indicated high study quality and low risk of bias.Meta-analysis showed that there were no significantly differences in mortality[relative risk(RR)=1.02,95%confidence interval(95%CI)was 0.79 to 1.31,P=0.88],the length of ICU stay[mean difference(MD)=-2.68,95%CI was-5.30 to-0.05,P=0.05]between the prone ventilation duration≤24 hours group and prone ventilation duration>24 hours group.Compared with the prone ventilation duration≤24 hours group,the incidence of pressure ulcers(RR=0.76,95%CI was 0.59 to 0.98,P=0.04)and the operation of tracheotomy(RR=0.71,95%CI was 0.53 to 0.94,P=0.02)were significantly increased in the prone ventilation duration>24 hours group.Conclusions The duration of prone ventilation had no significant effect on the mortality and the length of ICU stay in ARDS patients,but prone ventilation for>24 hours increased the incidence of pressure ulcers and the operation of tracheotomy,which still needs to be further verified by a large number of studies due to the small number of included studies.