早期气管切开对长期机械通气患者影响的系统评价

The timing of tracheostomy in patients undergoing artificial ventilation:a systematic review

目的:评价早期气管切开对长期机械通气患者临床结局的影响。方法:计算机检索PubMed、Cochrane library、中国生物医学文献光盘数据库(CBM)和中国知识基础设施数据库(CNKI),均从最初检索至2010年6月。手工检索纳入文献的参考文献。收集国内外关于早期气管切开对长期机械通气患者影响的随机对照试验,并进行系统评价。结果:共6篇文献入选,合并结果显示早期气管切开不能降低长期机械通气患者的病死率[RR0.87,95%CI(0.59,1.30)]、医院获得性肺炎发病率[RR0.89,95%CI(0.68,1.17)]和机械通气时间[WMD-4.49,95%CI(-11.64,1.77)]。结论:现有证据表明,早期气管切开并不能给长期机械通气患者带来益处,但尚需更多设计完好的大样本随机对照试验进一步验证。

Objective To compare outcomes in adult patients undergoing artificial ventilation who received an early tracheostomy and those who received a late tracheostomy. Methods Related references were collected from databases of the PubMed, Cochrane Library, CBM and CNKI from establishment to June 2010. Randomized controlled trials focusing on the effects of early tracheostomy on the prolonged endotracheal intubation were analyzed by a systematic review method. Results Six trials in total were screened and used for a recta-analysis. Early tracheostomy did not significantly alter mortality （RR 0.87, 95% CI 0.59 to 1.30）, risk of pneumonia （RR 0.89, 95% CI 0.68 to 1.17） and duration of artificial ventilation （WMD -4.49, 95% C1 -11.64 to 1.77）. Conclusions The systematic review does not demonstrate significant benefit of early tracheotomy to patients who need prolonged mechanical ventilation. However, this primary conclusion should be verified by using more prospective randomized trials.