声门下吸引预防呼吸机相关性肺炎有效性和安全性的系统评价再评价

Re-evaluation of the effectiveness and safety of subglottic suction in the prevention of ventilator-associated pneumonia

目的对声门下吸引预防呼吸机相关性肺炎的有效性及安全性的系统评价进行再评价。方法通过计算机检索中国知网(CNKI)、万方数据库(Wanfang)、中国生物医学文献数据库(CBM)、维普期刊(VIP)、Pubmed、Cochrane Library、Embase,检索时间从建库至2018年1月,筛选提取符合标准的系统评价/Meta分析,使用总体质量评估问卷(QQAQ)评价其方法学质量,用描述性分析的方法分析资料。结果共纳入19篇系统评价/Meta分析,方法学质量评分为4~9分,系统评价包括了声门下吸引的有效性和安全性。结局指标包括呼吸机相关性肺炎发生率、机械通气时间、住院时间、死亡率、隐血试验阳性、引流量等。结论持续声门下吸引与间歇声门下吸引都能有效预防机械通气相关性肺炎的发生,但持续声门下吸引易导致气道黏膜损伤,应客观评价声门下吸引的临床效果。

Objective To evaluate the effectiveness and safety of subglottic suction in preventing ventilator-associated pneumonia.Methods Databases including CNKI,CBM,VIP,Pubmed,Cochrane library,Embase from inception to January,2018 were searched for systematic reviews and Meta analysis.Screening and extracting systematic reviews and Meta analysis accord with the standard,QQAQ scale was used to assess methodological quality,using descriptive analysis methods to analyze data.Results Totally 19 systematic reviews/Meta analysis were included,methodological quality score were among 4~9 points,the effectiveness and safety of subglottic secretion drainage were systematically evaluated.Outcomes including incidence of ventilator associated-pneumonia,mechanical ventilation time,length of hospital stay,mortality,occult blood test,volume of drainage,etc.Conclusion Both continuous aspiration of subglottic secretion and intermittent aspirationf subglottic secretion can effectively prevent ventilator-associated pneumonia,but continuous aspiration of subglottic secretion is easy to damage the airway mucosa,therefore clinical effects should be objectively evaluated.