间歇声门下吸引预防呼吸机相关性肺炎的Meta分析和试验序贯分析

Intermittent subglottic secretion drainage for preventing ventilator-associated pneumonia:a meta-analysis and trial sequential analysis

目的探讨间歇性声门下吸引对呼吸机相关性肺炎(VAP)的预防作用。方法系统检索考克兰数据库、PubMed、Embase,检索日期为2016年12月。纳入9篇随机对照试验,1277例患者,比较间歇性声门下吸引与无声门下吸引预防机械通气患者发生VAP的随机对照试验。采用Meta分析和试验序贯分析的方法进行统计分析。结果 Meta分析结果表明,间歇性声门下吸引可降低VAP的发生率[RR 0.56,95%CI(0.45,0.69)],GRADE证据等级为高级。TSA分析进一步确认,间歇性声门下吸引还可显著减少早期VAP的发生率,并延缓VAP的发生时间。但间歇声门下吸引无法显著改善VAP晚期发生率、ICU死亡率、住院死亡率、气管切开发生率、机械通气时间、ICU和住院时间等指标。结论间歇性声门下吸引可减少VAP的发生率,并推迟VAP的发生时间,但并不能减少死亡率和ICU住院时间。建议对VAP高危患者采用间歇性声门下吸引治疗措施。

OBJECTIVE To investigate the effects of intermittent subglottic secretion drainage for preventing ventilator-associated pneumonia（VAP）.METHODS The Cochrane databases,PubMed and Embase were systematically retrieved up to December 2016.Totally 9 articles of randomized controlled trials（RCTs）of 1277 cases of patients were included.The incidence of VAP between intermittent subglottic secretion drainage and no subglottic secretion suction in mechanical ventilated patients were compared.Meta-analysis and trial sequential analysis（TSA）were used for statistically analyzed.RESULTS Meta-analysis showed that,intermittent subglottic secretion drainage could reduce the incidence of VAP [RR0.56,95% CI（0.45,0.69）]with high level of the Grading of Recommendations Assessment,Development and Evaluation（GRADE）.Additionally,TSA confirmed that,intermittent subglottic secretion drainage could also significantly reduce the incidence of early VAP,and delay the onset of VAP.However,intermittent subglottic secretion drainage could not significantly improve the he incidence of late VAP,ICU mortality,hospital mortality,tracheotomy rate,mechanical ventilation time,and ICU hospitalization time.CONCLUSIONIntermittent subglottic secretion drainage can reduce the incidence of VAP,and delay the onset of VAP,although does not reduce mortality and ICU stays.It is recommended to use intermittent subglottic secretion drainage for high-risk VAP patients.