不监测胃残余量对呼吸机相关性肺炎风险的Meta分析

Effects of not monitoring gastric residual volume on the risk of ventilator-associated pneumonia: a meta-analysis

目的探讨不监测胃残余量是否增加呼吸机相关性肺炎的风险。方法系统检索PubMed、Embase、Cochrane Library、中国知网、中国生物医学文献数据库和万方数据库,检索周期从建库到2019年1月。2位研究者独立完成文献的检索,并根据纳入和排除标准筛选文献并提取数据,采用RevMan5.3软件对符合要求的文献进行Meta分析。结果最终纳入4项研究,3项为随机对照研究,1项为队列研究,共785例患者。与常规监测胃残余量相比,不进行胃残余量监测没有增加呼吸机相关性肺炎的发生率,差异无统计学意义(RR值为1.30,95%CI 0.78~2.16,P值为0.32);然而,在不监测胃残余量组呕吐的发生率较高,差异有统计学意义(RR值为1.52,95%CI 1.20~1.91,P值为0.0004);同时,在不监测胃残余量组,喂养不耐受的发生率较低,差异有统计学意义(RR值为0.61,95%CI 0.51~0.72,P<0.01);2组患者在机械通气时间(MD值为0.39,95%CI-0.70^-1.47,P值为0.49)和ICU住院日(MD值为-0.19,95%CI-1.55^-1.16,P值为0.78)方面差异无统计学意义。结论与常规胃残余量监测相比,不进行胃残余量监测没有增加重症患者发生呼吸机相关性肺炎的风险,但对重症患者能否不再监测胃残余量尚需设计更加严谨的、大样本的临床试验进一步验证。

ed pertinent data.Relative risk(RR),weighted mean difference(MD),and 95%confidence interval(95%CI)were calculated and heterogeneity was assessed with the I2test.Results Four studies with a total of 785 patients were included in this meta-analysis.No monitoring gastric residual volume did not significantly increase the incidence of ventilator-associated pneumonia(RR=1.30,95%CI 0.78-2.16,P=0.32),compared with monitoring gastric residual volume.However,the incidence of vomiting in the no monitoring gastric residual volume group is higher(RR=1.52,95%CI 1.20-1.91,P=0.0004).Not monitoring gastric residual volume decreased the rate of feeding intolerance in critically ill patients(RR=0.61,95%CI 0.51-0.72,P<0.01).There were no differences in the duration of mechanical ventilation(MD=0.39,95%CI-0.70-1.47,P=0.49)and ICU length of stay(MD=-0.19,95%CI-1.55--1.16,P=0.78).Conclusion The absence of monitoring gastric residual volume did not increase the risk of ventilator-associated pneumonia in critically patient with mechanical ventilation.Gastric residual volume monitoring can not be used as a maker to prevent aspiration and to assess feeding intolerance.We still need to conduct large-scale,well-desighed clinical trials to verify whether gastric residual volume monitoring can be eliminated.