持续与间断气囊压力监控在机械通气病人中应用效果比较的Meta分析

Application effect comparision of continuous and intermitent control of tracheal tube cuff pressure in patients undergoing mechanical ventilation:a Meta⁃analysis

目的:系统评价持续和间断监控气囊压力监测的安全性和有效性。方法:系统检索PubMed、EMbase、The Cochrane Library以及中国生物医学文献数据库(SinoMed)、万方、中国知网等数据库中气囊压力持续或间断监控相关文献,检索日期从建库至2020年5月31日。由2名研究员分别进行文献筛选、数据提取和质量评价。结果:共纳入17篇随机对照研究,涉及1916例病人。Meta分析结果显示,与间断监控气囊压力相比,持续监控气囊压力可减少误吸的发生率[RR=0.35,95%CI(0.19,0.65),P=0.0009]和呼吸机相关性肺炎的发生率[RR=0.42,95%CI(0.35,0.50),P<0.00001],缩短机械通气时间[MD=-2.81,95%CI(-4.37,-1.26),P=0.0004]和重症监护室(ICU)住院时间[MD=-3.46,95%CI(-5.01,-1.91),P<0.0001]。两组病人的ICU病死率差异无统计学意义[RR=1.01,95%CI(0.84,1.21),P=0.95]。结论:现有证据表明,与间断监控气囊压力相比,持续监控气囊压力可降低误吸和呼吸机相关性肺炎的发生,缩短病人机械通气时间及ICU住院时间,但对ICU死亡率没有明显改善。

Objectives:To systematically evaluate the efficacy and safety of continuous and intermittent control of tracheal tube cuff pressure in critically ill patients.Methods:Literatures related to continuous and intermittent control of tracheal tube cuff pressure were searched in PubMed,EMbase,Cochrane Library,SinoMed,Wanfang,CNKI and so on.The search time was from databases established to May 31,2020.Literatures screening,quality evaluation and data extraction were independently conducted by two reviewers.Results:Toally 17 studies involving 1916 participants were enrolled.Meta-analysis showed that,compared with intermittent control of tracheal tube cuff pressure,continuous monitoring of puff pressure could reduce the incidence rate of aspiration[RR=0.35,95%CI(0.19,0.65),P=0.0009]and VAP[RR=0.42,95%CI(0.35,0.50),P<0.0001],shorter length of mechanical ventilation[MD=-2.81,95%CI(-4.37,-1.26),P=0.0004]and ICU stay[MD=-3.46,95%CI(-5.01,-1.91),P<0.0001].However,There was no significant differences in the mortality rate[RR=1.01,95%CI(0.84,1.21),P=0.95].Conclusions:Current evidences showed that,compared with intermittent control of tracheal tube cuff pressure,continuous control of tracheal tube cuff pressure could reduce the incidence of aspiration and VAP,shorten the length of mechanical ventilation time and ICU stay.However,there was no significant improvement on ICU mortality.