持续与间歇声门下吸引预防呼吸机相关性肺炎效果的Meta分析

Continuous versus intermittent aspiration of subglottic secretion for preventing ventilator-associated pneumo-nia:a meta-analysis

目的系统综述持续和间歇声门下吸引预防呼吸机相关性肺炎的效果.方法计算机检索Cochrane图书馆、PubMed、MEDLINE、EMBASE、Web of Science、中国生物医学文献数据库、中国知网、万方和维普数据库自1994年7月—2019年7月国内外公开发表的随机对照试验,进行文献筛选、质量评价、数据提取,采用RevMan 5.3软件进行Meta分析.结果共纳入18篇文献,1951例患者.Meta分析结果显示,两组呼吸机相关性肺炎发生率和发生时间、气囊上滞留物吸引量、机械通气时间、ICU住院时间差异无统计学意义(P>0.05),气囊上滞留物隐血试验阳性率差异有统计学意义(P<0.01).结论与间歇声门下吸引相比,持续声门下吸引并不能降低VAP发生率、机械通气时间、ICU住院时间,也不能延缓VAP发生时间和增加气囊上滞留物吸引量,且存在增加气道黏膜损伤的风险.

Objective To compare the effectiveness between continuous aspiration of subglottic secretion(CASS)and intermittent aspiration of subglottic secretion(IASS)in mechanical ventilation patients for preventing ventilatorassociated pneumonia(VAP).Methods Randomized controlled trials published from July 1994 to July 2019 were identified by searching Cochrane Library,PubMed,MEDLINE,EMBASE,Web of Science,China Biology Medicine database,CNKI,Wangfa and VIP Database.Two reviewers independently screened the studies according to the inclusive and exclusive criteria,assessed the quality and extracted the data.Then RevMan 5.3 software was used for Meta-analysis.Results Eighteen studies enrolling a total of 1951 patients met the inclusion criteria.Meta-analysis showed no significant difference between two groups for the incidence of VAP,time to VAP occurrence,the aspirated secretion volume,duration of mechanical ventilation,length of ICU stay(P>0.05).The positive rate of occult blood test in CASS group was higher(P<0.01).Conclusion The results indicate no significant differences between the two groups for preventing VAP.But the risk of tracheal wall injury in CASS is higher than that in IASS.