呼吸末正压通气预防术后肺部并发症效果的Meta分析

Positive End-Expiratory Pressure(PEEP) during Anaesthesia for Prevention of Postoperative Pulmonary Complications: A Meta-Analysis

目的 系统评价呼吸末正压通气（positive end-expiratory pressure，PEEP）对预防术后肺部并发症的效果，为临床制定合理的呼吸管理策略提供循证医学证据。方法 计算机检索PubMed、EMbase、The Cochrane Library（2012年第3期）、CBM和CNKI，收集关于围术期PEEP预防肺部并发症效果的随机对照试验（RCT），检索时限均为从建库至2013年1月。由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.1软件进行Meta分析。结果 最终纳入8个RCT，共336例患者。Meta分析结果显示：PEEP与常规通气在围术期死亡率方面无明显差异［OR=0.95，95% CI（0.13，6.92），P=0.96］；PEEP能提高术后1天的氧合指数［MD=22.98，95%CI（4.40，41.55），P=0.02］，但两者在术后2～3天的氧合指数方面无明显差异［MD=12.59，95%CI（–6.78，31.96），P=0.31］；PEEP在降低术后肺不张发生率方面优于常规通气［OR=0.27，95% CI（0.08，0.9），P=0.03］。结论 全麻期间采用PEEP能提高术后1天的氧合指数，降低术后肺不张的发生率，对患者肺功能具有一定的保护作用。由于纳入研究的数量和质量限制，本研究结论尚需高质量、大样本的RCT验证。

ObjectiveTo systematically evaluate the benefits and harms of intraoperative positive end-expiratory pressure （PEEP） to all adult patients suffered surgery, especially on the postoperative mortality and pulmonary outcomes. MethodsWe electronically searched PubMed, EMbase, The Cochrane library （Issue 3, 2012） , CBM, CNKI from inception to January 2013, for randomized controlled trials （RCTs） about PEEP for the prevention of pulmonary complications. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 8 RCTs involving 336 patients were finally included. The results of meta-analysis showed that there was no difference between two groups in mortality （OR=0.95, 95%CI 0.13 to 6.92, P=0.96）. However, the PEEP group had a higher PaO2/FiO2the first day after surgery （MD=22.98, 95%CI 4.40 to 41.55, P=0.02）, while there was no difference 2-3 days after surgery （MD=12.59, 95%CI –6.78 to 31.96, P=0.31）. Meanwhile, postoperative atelectasis was less in the PEEP group （OR=0.27, 95%CI 0.08 to 0.9, P=0.03）. ConclusionChoosing PEEP mode during general anaesthesia may improve postoperative oxygenation index in the first day after surgery, and reduce pulmonary complications, which has a protective effect on patients pulmonary function. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.