呼吸机管路更换对呼吸机相关肺炎影响的荟萃分析

Effects of ventilator circuit change frequency on ventilator-associated pneumonia： Meta-analysis

目的评价呼吸机管路更换对呼吸机相关肺炎（ventilator-associatedpneumonia，VAP）的影响。方法通过计算机检索和手工检索全面收集国内外1995--2010年机械通气患者更换呼吸机管路的随机对照试验（RCT），按Cochrane协作网推荐的方法对呼吸机相关肺炎发生率作Meta分析。结果共纳入9篇文献，患者总数20326人。纳入6篇文献进行Meta分析发现每2到3d更换呼吸机管路VAP的发生率为4．05％，每7d更换呼吸机管路VAP的发生率为3．65％，与每2到3d更换呼吸机管路相比，每7d更换呼吸机管路呼吸机相关肺炎发生率的RR值为0．77[0．54，1．09]（P=0．14）；纳入3篇文献进行分析发现每7d更换呼吸机管路VAP的发生率为15．89％，大于14d更换呼吸机管路VAP的发生率为14．9％，与每7天更换呼吸机管路相比，大于14d更换呼吸机管路呼吸机相关肺炎发生率的RR值为0．98Eo．69，1．39]（P=0．91）。结论定期更换呼吸机管路并不能降低机械通气患者呼吸机相关肺炎的发生率。

Objective To evaluate the effects of ventilator circuit change frequency on ventilator- associated pneumonia （VAP）. Methods Meta-analysis of effects of ventilator circuit change frequency on VAP was conducted with study-level data from 1995 to 2010 in Pubmed, Embase, Web of Science databases. Results Nine articles were included （sample size： 20 326 mechanically ventilated patients）. Analysis of six articles showed that the incidence of VAP in ventilator circuit change every 2 or 3 days was 4. 05%, while 3.65% in ventilator circuit change every 7 days. Compared with change ventilator circuit every 2 or 3 days, the risk ratio （RR） of VAP in weekly changes was 0. 77 [ 0. 54, 1.09 ] （ P = 0. 14）. Analysis three articles showed that compared to ventilator circuit change every 7 days with 15. 89% incidence of VAP, the incidence of VAP in circuit change more than 14 days was 14. 9%, and RR was 0. 98 [0. 69, 1.39 ] （P = 0. 91 ）. Conclusions Regular ventilator circuit change frequency in various intervals can＇t difference in the incidence of VAP in mechanical ventilation patients.