经皮扩张气管切开术与传统气管切开术治疗危重患者的Meta分析

Percutaneous dilatational tracheostomy versus surgical tracheostomy for critical illness patients: a Meta-analysis

目的:评价经皮扩张气管切开术与传统气管切开术术后的疗效和并发症。方法:按照Cochrane协作网系统评价的方法,检索所有发表于国内外杂志上有关比较经皮扩张气管切开术(percutaneous dilatational tracheostomy,PDT)与传统气管切开术(surgical tracheostomy,ST)治疗危重患者的随机对照试验。检索数据库包括Pub Med、EMBase、Web of Science、The Cochrane library、CBM、CNKI、VIP、万方等数据库,并检索所有纳入研究的参考文献。由两名评价员对检索文献进行筛选并按照Cochrane Handbook5.1对纳入文献进行质量评价。用Rev Man5.2软件对主要测量指标进行统计分析。结果:共纳入23个随机对照试验,共1686例患者。Meta分析结果显示,与ST相比,PDT能降低切口感染发生率[OR=0.20,95%CI(0.12,0.34)P<0.05]和出血率[OR=0.51,95%CI(0.32,0.81),P<0.05]。亚组分析结果显示,当气管切开在手术室完成时,与ST相比,PDT降低了术后患者病死率[OR=0.70,95%CI(0.49,1.00),P<0.05]。结论:与ST相比,PDT能降低切口感染发生率和出血率,在降低病死率上有一定的优势。

Objective： To evaluate the clinical effectiveness of percutaneous dilatational tracheostomy（ PDT ） versus surgical tracheostomy （ST） for critical illness patients. Methods： The following electronic databases as PubMed, EMBase ,Web of Science,the Cochrane library, CBM ,CNKI,VIP and WanFang data were searched on computer from inception to April 2013 and the references of all selected studies were also retrieved to collect the relevant randomized controlled trials （RCTs） on PDT vs ST for critical illness patients.The quality of included studies was evaluated according to the criteria of Cochrane Handbook5.1 and Meta-analyses were performed by RevManS.2 software. Results： A total of 23 RCTs involving 1686 patients were included. Meta-analyses showed that PDT had the tendency of reducing incidence of wound infection [OR=O.20,95%CI（0.12,0.34）,P〈0.05] and bleeding [0R=0.51, 95%CI （0.32,0.81）,P〈0.05] when compared with ST. There was no significant difference in mortality between PDT and ST. However,subgroup analysis showed that PDT resulted in a lower incidence of wound infection [0R=0.25,95%C1 （0.13,0.47）,P〈0.05], bleeding[OR=0.27,95%Cl（0.12,0.75）,P〈O.OS]and mortality[OR=0.70,95%Cl（0.49,1.00）,P〈0.05] when STs were performed in operating theatre. In addition PDT resulted in a lower incidence of wound infection[OR=0.18,95%Cl（0.08,0.40）,P〈0.05], and there was no significant difference between PDT and ST in incidence of bleeding and mortality when STs were performed in intensive care unit. Conclnsions：Compared with ST, PDT significantly reduce the incidence of wound infection and bleeding, and also has advantage in reducing mortality.