无创正压通气降低机械通气相关肺炎发生危险的Meta分析

Noninvasive positive-pressure ventilation reduces incidence of ventilator-associated pneumonia= a Meta-analysis

目的探讨无创正压机械通气（noninvasive positive—presureventilation，NPPV）与患者机械通气相关肺炎（ventila-tor—associatedpneumonia，VAP）发生率的关系。方法通过计算机检索Medline、EMBASE、CENTRAL、中国生物医学文献数据库系统、中文科技期刊全文数据库等，收录公开发表的无创正压机械通气与患者肺炎发生率的研究文献。应用Statall．0统计软件进行数据分析，计算其合并相对危险度和95％置信区间，并检验其异质性及文献性偏倚。结果共纳入分析文献8篇，受试者520例，其中NPPV组257例，对照组263例。NPPV组发生肺炎33例（12．8％）。对照组发生肺炎75例（28．5％o与有创机械通气比较，NPPV可以降低66％的肺炎发生危险（P=0．005）；与标准治疗比较，NPPV可以降低49％的肺炎发生危险（P=0．0285o各独立研究结果不存在统计学异质性（P〉O．05），亦无文献发表性偏倚（P〉O．05o结论NPPV可以显著降低患者VAP的发生危险。

Objective To investigate the risk of ventilation-associated pneumonia （VAP） in noninvasive positive-pres- sure ventilation （NPPV）. Methods By searching Medline, PubMed, CENTRA （the Cochrane central register of controlled trials）, CBM, CNKI and VIP, the published clinical trials on incidence of VAP in NPPV were collected. The data was analyzed by using statistic software Statal 1.0. The combined relative risk （RR）, the 95% confidence interval （CI） and publication bias were estimat- ed. Results Eight randomized controlled trials （RCT） and 520 subjects were included into the combined analysis. The results indicated that the noninvasive positive-pressure ventilation decreased 66%（RR=0.34, 95%CI.0.16 - 0.72, P=0.005） and 49% （RR=0.61, 95%C1-0.39 - 0.99, P=0.0285） risk of pneumonia compared to invasive mechanical ventilation and standard therapy respectively. No statistical heterogeneity and publication bias were found among the original studies （P 〉0.05）. Conclusion The noninvasive positive-pressure ventilation can decrease the risk of pneumonia compared to invasive mechanical ventilation and standard therapy.