持续监测和控制人工气道气囊压力对机械通气患者呼吸机相关肺炎发生率影响的Meta分析

Effect of continuous monitor and control cuff pressure on the incidence of ventilator associated pneumonia in mechanical ventilation patients: a meta-analysis

目的系统评价机械通气患者持续或间断监测和控制人工气道气囊压力对呼吸机相关肺炎(VAP)发生率的影响。方法计算机检索Pub Med、Medline、EMbase、OVID、Cochrane、CNKI中国知网、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、万方数据库中关于持续监测和控制人工气道气囊压力(干预组)及间断监测和控制人工气道气囊压力(常规组)对机械通气患者VAP发生率影响的随机对照研究,检索时间为2006年1月到2015年12月。由2名研究者按照纳入及排除标准独立进行文献筛选、资料提取和质量评估后,采用Revman 5.3软件对数据进行Meta分析。结果共纳入6篇文献,机械通气患者1 263例,其中进行持续监测和控制人工气道气囊压力的干预组机械通气患者654例,进行间断监测和控制人工气道气囊压力的常规组机械通气患者609例。Meta分析结果显示,干预组患者VAP发生率较常规组明显降低[OR=0.43,95%CI(0.31,0.60),Z=5.53,P<0.05]。但干预组患者ICU病死率较常规组未明显降低,两组比较差异没有统计学意义[OR=1.02,95%CI(0.71,1.46),Z=0.36,P>0.05]。结论对机械通气患者进行持续监测和控制人工气道气囊压力可以降低VAP发生率,但对ICU病死率没有明显影响。

Objective To assess the effect of continuous monitor and control cuff pressure on the incidence of ventilator associated pneumonia （VAP） in the mechanical ventilation patients. Methods The randomized controlled trials （RCTs） on the effect of the incidence of VAP in the mechanical ventilation patients undergoing continuous monitor and control cuff pressure （treatment group） or discontinuous monitor and control cuff pressure （control group） were conducted in PubMed, Medline, Embase, OVID, Cochrane, CNKI, CBM, VIP and Wanfang database from January 2006 to December 2015. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted the data and evaluated the quality of the included studies. The meta-analysis was performed using Revman 5.3. Results Six studies involving 1 263 mechanical ventilation patients （654 patients in the treatment group and 609 patients in the control group） were included in the RCTs. The results of meta-analyses showed that the incidence of VAP in the treatment group was much lower than that in the control group [OR = 0.43, 95%CI （0.31, 0.60）, Z= 5.53, P〈 0.05]. However, there was no significant difference in ICU mortality between the two groups [OR = 1.02, 95%CI （0.71, 1.46）, Z = 0.36, P〉 0.05]. Conclusion Continuous monitor and control cuff pressure can reduce the incidence of VAP in the mechanical ventilation patients, but had no significant effeet on ICU mortality.