院前与入院后气管插管对重型颅脑损伤患者预后影响的Meta分析

Meta-analysis of Different Effects of Pre-hospital and Hospital Endotracheal Intubation on Prognosis of Patients with Severe Traumatic Brain Injury

目的评价院前急救中气管插管与入院后插管对重型颅脑损伤患者预后的影响。方法计算机检索PubMed、EMbase、The Cochrane Library、Ovid、CNKI、CBM、万方和维普数据库中有关院前急救中气管插管对重型颅脑损伤患者预后影响的研究,追溯纳入文献和相关综述的参考文献,检索时限均由建库至2017年12月。由2位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析,使用STATA 12.0软件进行敏感性分析,绘制漏斗图分析纳入文献的发表偏倚。结果最终纳入8篇文献,共17 604例患者。Meta分析结果显示:与入院后气管插管组相比,对重型颅脑损伤患者院前急救进行气管插管后,增加患者的病死率[RR=1.15,95%CI(1.09～1.20),P<0.00001]及ICU住院时间[SMD=0.56,95%CI(0.12～1.00),P=0.01];其次,对肺炎发生率[RR=1.28,95%CI(0.95～1.71),P=0.10]及机械通气时间[SMD=0.15,95%CI(-0.08～0.37),P=0.20]差异无统计学意义。敏感性分析显示结果较为稳健,发表偏倚检测显示无明显发表偏倚。结论院前急救中对重型颅脑损伤患者行气管插管可能增加患者病死率,延长ICU住院时间,但对患者入院后肺炎发生率和机械通气时间无显著影响。受纳入研究质量和数量的限制,上述结论有待更多高质量的研究验证。

Objective To evaluate of the different effects of pre-hospital endotracheal intubation and hospital intubation on the prognosis of patients with severe traumatic brain injury. Methods Literatures of the effect of pre-hospital endotracheal intubation on the prognosis of patients with severe traumatic brain injury were collected from PubMed, EMbase, Ovid, Cochrane Library, CNKI, CBM, Wanfang Data and VIP database from the inception till December 2017 and the references of related literatures were collected as we Two researchers screened publications independently and methodology quality of the included references was evaluated Meta-analysis was performed by using RevMan 5.3 software and Stata 12.0 software was used for sensitivity analysis and funnel chart was created for the publication bias of the literatures. Results Eight studies involving 17,604 patients were finally included. The results of meta-analysis showed that the mortality[RR=1.15,95%CI（1.09-1.20）, P〈0.00001] and ICU length of stay[SMD=0.56,95%CI （0.12-1.00）,P=0.01] of patients with severe traumatic brain injury were increased after pre-hospital tracheal intubation when compared with those after hospital intubation, but pre-hospital tracheal intubation exerted no effect on the incidence of pneumonia [RR=1.28,95%CI （0.95-1.71）,P=0.10] and duration of mechanical ventilation [SMD=0.15,95%CI （-0.08-0.37）,P=0.20]. Sensitivity analysis showed that the results were stable, and no obvious bias was found in the test of publication bias. Conclusion Pre-hospital endotracheal intubation in patients with severe traumatic brain injury may increase the mortality and prolong the duration of ICU length of stay, but has no significant effect on the incidence of pneumonia and the duration of mechanical ventilation. However, more quality RCTs are needed to confirm the conclusion.