持续声门下吸引预防呼吸机相关性肺炎的Meta分析

Continuous aspiration of subglottic suction for preventing ventilator associated pneumonia： a metaanalysis

目的系统评价持续声门下吸引（CASS）对机械通气患者呼吸机相关性肺炎（VAP）发生率及其他结局指标的影响。方法检索1994年7月至2014年7月PubMed、CochraneLibrary、Ovid、EBSCOhost、ScienceDirect、GoogleScholar、中国生物医学文献服务系统（CBM）、中国知网（CNKI）、万方数据库中所有涉及CASS预防机械通气患者VAP效果的随机对照实验（RCT），并辅以手工检索，严格按照纳入、排除标准筛选文献，对符合要求的文献进行质量评价和资料提取，采用RevMan5．1软件进行Meta分析。结果共纳入7个RCT研究，1566例患者。使用CASS的机械通气患者与对照组相比，VAP的发生率显著降低（RR=0．54，95％C10．43—0．65，P〈0．01），VAP发生时间延长（MD=3．52，95％C11．98～5．06，P〈0．01），机械通气时间缩短（MD=-2．03，95％CI-2．23—1．73，P〈0．01），人住ICU时间缩短（MD=-2．99，95％CI-3．75～2．23，P〈0．01）。CASS组中发生VAP者日平均引流量较未发生VAP者显著下降（MD=-25．06，95％CI-30．04—20．08，P〈0．01），但是在死亡率方面比较差异无统计学意义（RR=0．98，95％C10．80。1．20，P〉0．05）。结论采取CASS能预防机械通气患者VAP的发生，由于有关的RCT数量相对较少、质量欠佳，需要高质量的大规模RCT进一步证实。

Objective To systemically analyze the effect of continuous aspiration of subglottic suction （CASS） on the incidence of ventilator-associated pneumonia （VAP） and other outcomes in mechanieal ventilated patients. Methods PubMed, Cochrane Library, Ovid, EBSCOhost, ScienceDirect, Google scholar, CNKI, CBM and Wanfang Database were searched for the RCTs about the effect of CASS on the outcomes of mechanical ventilated patients from July 1994 to July 2014,and the relevant journals were also hand-searched. Data were extracted independently by two reviewers. Meta analysis was conducted using RevMan 5.1 software. Results Data extracted from 7 RCTs with a total of 1 566 patients were analyzed. The risks of developing clinically diagnosed VAP were significantly lower among the patients receiving CASS [RR =0.54,95% CI（0.43,0.65） ,P〈0.01],episodes of VAP occurred later in patients receiving CASS [MD=3.52,95%CI（1.98,5.06） ,P〈0.01], the duration of mechanical ventilation [MD=-2.03,95%CI（-2.23, -1.73） ,P〈0.01]and length of ICU stay were reduced [MD=-2.99,95%CI（-3.75,-2.23）,P〈0.01] ,while no significant differences were detected between the two groups regarding the mortality rate [RR=0.98,95%CI （0.80,1.20）,P〉0.05]. Conclusion This study proved that the CASS did have effect in reducing the incidence of VAP, but it is limited by lack of enough RCTs with high quality. Large sample of high quality RCTs is necessary to examine the wider applicability of CASS.