两种不同气道湿化方法对气管切开患者影响的Meta分析

Effects of two different methods for airway humidification for patients with tracheostomy： a Meta-analysis

目的评价持续性气道湿化对气管切开患者的影响，为临床提供证据支持及指导意见。方法计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMBASE数据库、JBI循证护理中心图书馆、Cochrane临床试验数据库、中国知网CNKI、万方数据库、维普数据库VIP、中国生物医学文献数据库（CBM），自建库起至2015年3月发表的文献。纳入比较两种不同气道湿化方法对气管切开患者并发症影响的随机对照试验（RCT），研究对象为年龄≥18岁、无上呼吸道感染病史、营养状态良好、气管切开术后的患者。试验组采用持续性气道湿化；对照组采用间断性气道湿化。由2名评价员独立筛选和评价文献，提取数据。对纳入文献进行Meta分析。结果最终纳入9篇文献共631例患者；试验组316例，对照组315例。Meta分析结果显示，持续性气道湿化可以降低气管切开患者的刺激性干咳率[优势比（OR）=0．20，95％可信区间（95％CI）=0．12～0．34，P〈0．00001]、呼吸道黏膜出血率（OR=0．25，95％CI=0．14-0．45，P〈0．00001）、痰痂形成率（OR=0．19，95％CI=0．10～0．39，P〈0．00001）、肺炎发生率（OR=0．29，95％CI=0．19～0．45，P〈0．00001）。敏感性分析显示该研究稳定性较好，各指标的漏斗图显示各研究没有发表偏倚。结论持续性气道湿化能够降低气管切开患者的并发症。但纳入文献数量偏少，且有些文献质量偏低，仍需要加大样本量进一步研究论证。

Objective To evaluate the effects of two different kinds of airway humidification for tracheostomy patients, and to provide their relevant clinical effect and suggestions for their use. Methods Online databases, including PubMed, EMBASE, JBI evidence-based nursing center library, the Cochrane Library, and Chinese databases （CNKI, Wanfang database, VIP, CBM） were searched systematically up to March 2015. Randomized controlled trials （RCTs） were considered eligible for inclusion if the following criteria were met： no history of respiratory tract infection; satisfactory nutritional status; tracheotomy performed; 18 years older. Two different humidification methods were used. Continuous airway humidification was used in the experiment group, while intermittent airway humidification was used in the control group. Two qualified reviewers reviewed the original articles, evaluating the quality of articles, and data were extracted independently. The enrolled RCTs were analyzed by Meta-analysis. Results A total of nine RCTs were included, containing 631 cases, among them 316 cases in expertment group, and 315 cases in control group. Continuous airway humidification was shown to be able to reduce the incidence of irritable cough [odds ratio （OR） = 0.20, 95% confidence interval （95%CI） = 0. 12-0.34, P 〈 0.000 01], bleeding form mucosa of respiratory tract （OR = 0.25, 95%CI = 0.14-0.45, P 〈 0.000 01）, sputum conglomeration （OR = 0.19, 95%CI = 0.10-0.39, P 〈 0.000 01）, and pneumonia （OR = 0.29, 95%CI = 0.19-0.45, P 〈 0.000 01）. The funnel plots were largely symmetrical, suggesting there was no publication bias in the Meta-analysis of two methods for airway humidification for tracheostomy patients. Conclusion Because the number of including articles was relative small, and the quality of some articles was poor, it is impossible to draw a reliable conclusion that continuous airway humidification could lower the incidence of complications for patients undergone tracheostomy.