国内慢性阻塞性肺疾病患者有创机械通气撤机应用膈肌超声诊断价值的Meta分析

Diagnostic value of diaphragm ultrasound in invasive mechanical ventilation in patients with COPD in China:a meta-analysis

目的评价膈肌超声预测国内慢性阻塞性肺疾病(COPD)患者有创机械通气撤机的临床诊断价值。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献服务系统、中国知网、万方、维普等数据库,截至2019年12月31日,以英文或中文出版的文献。筛选符合纳入条件的研究,并提取评价膈肌超声指标诊断试验相关数据,以临床实际成功撤机为诊断试验金标准,重建2×2列联表。使用Review Manager 5.3中的QUADAS-2进行质量评估。用Meta-Disc 1.4中的Cochran Q test和I^(2)统计数据。用Stata12的Begg's检验和Eegg's检验估计发表偏倚。结果纳入了6项研究,共有412例受试者。隔肌位移、隔肌厚度分数和隔肌位移与隔肌厚度分数联合的敏感度分别为0.872、0.840和0.856,特异度分别为0.644、0.827和0.728,诊断比值比分别为47.858、23.742和31.184,曲线下面积分别为0.9388、0.8984和0.9095。在这些研究中没有观察到发表偏倚。结论膈肌超声检查是预测国内COPD患者有创机械通气撤机的有效工具,可作为重要的诊断指标。

Objective Weaning failure is common in mechanically ventilated patients with chronic obstructive pulmonary diseases(COPD).This meta-analysis was performed to assess the clinical diagnostic value of diaphragmatic ultrasound for COPD patients predicting invasive mechanical ventilation in China.Methods Literature search was performed in PubMed,Embase,Cochrane Library,Web of Science,China Biomedical Literature Service System,Chinese National Knowledge Infrastructure(CNKI,in Chinese),Wanfang(in Chinese)databases and Database of Chinese science and technology periodicals,published in English or Chinese up to December 31,2019.The studies that met the inclusion conditions were screened,and the relevant data of the diaphragmatic ultrasound index diagnostic test was extracted.The 2×2 contingency table was reconstructed based on the successful clinical withdrawal as the gold standard of the diagnostic test.Methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)in Review Manager 5.3.Statistics was evaluated using Cochran Q test and I^(2) statistics in Meta-DiSc 1.4.Publication bias was assessed using Stata12's Begg's test and Eegg's test.Results Six studies with 412 subjects were included in this meta-analysis.The sensitivity of the diaphragm excursion(DE),diaphragm thickness fraction(DTF),and the combined sensitivity of the DE with DTF were 0.872,0.840,and 0.856.The specificity were 0.644,0.827,and 0.728.The diagnostic odds ratios were 47.858,23.742,and 31.184.The areas under the curve were 0.9388,0.8984 and 0.9095.Publication bias was not observed among these studies.Conclusions Diaphragmatic ultrasonography is an effective tool to predict weaning invasive mechanical ventilation for COPD patients in domestic,and can be used as an important diagnostic index.