密闭式和开放式吸痰系统预防呼吸机相关性肺炎效果的Meta分析

Efficacy of closed and open tracheal suction systems for prevention of ventilator-associated pneumonia: a meta-analysis

目的系统评价密闭式和开放式吸痰系统预防呼吸机相关性肺炎(VAP)的效果。方法计算机检索The Cochrane Library、CNKI、WanFang Data、Airiti Library、PubMed、CINAHL和Proquest数据库,搜集关于密闭式与开放式吸痰系统预防VAP效果的随机对照试验(RCT),检索时限均从2010年1月至2020年5月。由2位研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括1187例患者。Meta分析结果显示,与开放式吸痰系统相比,密闭式吸痰系统可降低VAP的发生率[RR=0.55,95%CI(0.44,0.67),P<0.00001]和晚发型VAP的发生率[RR=0.47,95%CI(0.28,0.80),P=0.005],缩短重症监护病房住院日[MD=−0.85,95%CI(−1.66,−0.04),P=0.04]和降低呼吸道微生物定植率[RR=0.69,95%CI(0.56,0.86),P=0.0009]。但两组在VAP发生时间[MD=0.96,95%CI(−0.21,2.12),P=0.11]、机械通气时间[MD=−2.24,95%CI(−4.54,0.06),P=0.06]和住院病死率[RR=0.88,95%CI(0.73,1.05),P=0.15]方面的差异均无统计学意义。结论当前证据显示,与开放式吸痰系统比较,密闭式吸痰系统更能预防VAP的发生,且缩短重症监护病房住院日和降低呼吸道微生物定植率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Methods The Cochrane Library, CNKI, WanFang Data, Airiti Library,PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials(RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. Results A total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia(RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia(RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit(MD=-0.85,95%CI-1.66 to-0.04, P=0.04) and rate of microbial colonization(RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However,there were no significant differences between two groups in time to ventilator-associated pneumonia development(MD=0.96, 95%CI-0.21 to 2.12, P=0.11), length of mechanical ventilation(MD=-2.24, 95%CI-4.54 to 0.06, P=0.06), and rate of mortality(RR=0.88, 95%CI 0.73 to 1.05, P=0.15). Conclusions Current evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.