呼吸系统弹性阻力对急性肺损伤患者肺复张后氧合影响的荟萃分析

Effects of respiratory system elasticity resistance on oxygenation after recruitment maneuvers of ALI patients： a meta-analysis

目的 探讨呼吸系统弹性阻力（respiratory system elasticity resistance,Ers）在急性肺损伤（acute lung injury,ALI）患者肺复张过程中氧合的影响.方法 收集1999年1月1日至2010年6月30日关于在肺复张对不同Ers急性肺损伤患者氧合影响的随机对照研究、前瞻观察性研究和病例对照研究,对于肺复张对Ers≥33.3 cmH2O/L（1 cmH2O=0.098 kPa）和Ers＜33.3 cmH2O/L（1 mmHg=0.133 kPa）的ALI患者氧合影响作Meta评价.结果 共281篇文献符合纳入标准,纳入文献共20篇,共纳人患者共395人,结果提示肺复张对高Ers患者氧合改善为（51.97±8.89）mmHg,血压下降（4.33±1.32）mmHg;对低Ers患者氧合改善为（35.13±10.33）mHg,血压下降（0.22±1.03）mmHg,肺复张对两组患者之间氧合改善和血压的影响差异具有统计学意义（P＜0.01）.结论 肺复张能够改善ALI患者的氧合,对高Ers的ALI患者氧合改善更为明显;但对高Ers的患者循环影响更为明显.

Objective To investigate the effects of elasticity resistance （Ers） in respiratory system on oxygenation in patients with acute lung injury （ALI） after recruitment maneuvers （RM）. Method Meta-analysis of data about the effects of recruitment maneuvers on oxygenation in ALI patients with different elasticity resistances in respiratory system carried out with pooling of study-oriented data stored in Pubmed, Embase, Web of Science databases from January 1999 to June 2010. Results A total of 281 articles were taken, and 20 of them included a sample size of 395 ALI patients. In patients treated with RM in different degrees of respiratory system elasticity resistance （ ≥33.3 cmH2O/L and 〈33.3 cmH2O/L）, the effect of RM was better in patients with the high respiratory system elasticity resistance than that with the low one [（51.97 ＋ 8.89） mmHg vs. （35.13 ± 10.33 ） mmHg], P 〈 0. 01 ）, but the high respiratory system elasticity resistance was potentially to lower blood pressure [（4. 33 ± 1.32 ） mmHg vs. （0.22 ± 1.03 ） mmHg],P 〈 0.01 ）. Conclusions This study suggests RM could improve oxygenation of ALI patients with high respiratory system elasticity resistance, and caution must be made to avoid hypotension during RM.