呼吸机管路更换时间对VAP发病率影响的系统评价

Effect of ventilator circuit changes on incidence of ventilator-associated pneumonia:a systematic review

目的系统评价呼吸机管路更换时间对呼吸机相关肺炎(VAP)发病率的影响。方法计算机检索PubMed,Cochrane Library、中国知网全文数据库(CNKI)、维普数据库、万方数据库中有关呼吸机管路更换时间对VAP发生影响的文献,比较不同呼吸机管路更换时间患者VAP的发病率,以比值比(OR)及其95%CI为本次研究的效应指标。应用RevMan 5.2软件进行数据分析。结果最终纳入12篇文献,包括18 003例使用呼吸机的患者。按呼吸机管路更换时间分为1d组191例、2d组8 932例、3d组228例和7d组8 652例。Meta分析结果显示,7d组的VAP发生危险性低于1d组[OR=3.72,95%CI(1.50,9.23)],7d组与2d组VAP发生危险性无差别[OR=1.17,95%CI(1.00,1.37)],7d组与3d组VAP发生危险性无差别[OR=0.77,95%CI(0.49,1.23)]。结论机械通气患者每7天更换1次呼吸机管路发生VAP的危险低于每日更换,机械通气患者每7天更换1次呼吸机管路更为合理。

ObjectiveTo evaluate systematically the effect of ventilator circuit changes on incidence of ventilatorassociated pneumonia（VAP）. MethodsLiteratures about the effect of ventilator circuit changes on occurrence of VAP were searched from PubMed, Cochrane Library, CNKI, VIP, and Wanfang database, incidence of VAP in patients who received circuit changes at different intervals was compared, odds ratio （OR） and 95%CI were as effect index of the study, RevMan 5.2 software was used for data analysis. ResultsA total of 12 literatures were included, including 18 003 patients using ventilators. According to the interval of ventilator circuit changes, patients were divided into 1day group （n=191）, 2day group（n=8 932）, 3day group（n=228）, and 7day group（n=8 652）. Meta analysis showed that circuit changed every 7 days had a lower risk of VAP than that changed once every day （OR, 3.72[95%CI, 1.50,9.23]）, there was no significant difference in risk of VAP between 7day group and 2day group （OR, 1.17[95%CI, 1.00,1.37]）as well as 7day group and 3day group（OR, 0.77 [95%CI, 0.49,1.23]）. ConclusionPatients who received circuit changes every 7 days have a lower risk of developing VAP than those who received circuit changes once per day, so change the ventilator circuit in patients with mechanical ventilation every 7 days is more reasonable.