压力控制容量保证模式用于老年患者术中机械通气的Meta分析

Pressure-controlled ventilation-volume guaranteed for intraoperative mechanical ventilation in elderly patients:a meta-analysis

目的系统评价压力控制容量保证模式(PCV-VG)用于老年患者术中机械通气的有效性和安全性。方法计算机检索PubMed、Web of Science、The Cochrane Library、中国期刊全文数据库(CNKI)、万方和维普数据库,检索PCV-VG用于老年患者术中机械通气的随机对照试验(RCT),检索时限均从建库至2022年1月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入12篇文献,共计患者749例,PCV-VG组374例,对照组375例。术中机械通气时两组PaO_(2)(MD=5.32 mmHg,95%CI-0.55~11.18,P=0.08)、PaCO_(2)(MD=0.12 mmHg,95%CI-0.18~0.41,P=0.43)差异无统计学意义。与对照组比较,PCV-VG组术中机械通气时气道峰压(Ppeak)明显下降(MD=-3.40 cmH_(2)O,95%CI-4.69~-2.12,P<0.001),肺动态顺应性(Cdyn)明显升高(MD=3.85 ml/cmH_(2)O,95%CI 2.46~5.25,P<0.001)。术中机械通气时两组MAP(MD=-0.22 mmHg,95%CI-1.45~1.01,P=0.72)差异无统计学意义。结论PCV-VG用于老年患者术中机械通气时,可以降低老年患者Ppeak、提高Cdyn,但不影响PaO_(2)、PaCO_(2)和MAP。

Objective To systematically evaluate the efficacy and safety of pressure-controlled ventilation-volume guaranteed(PCV-VG)for intraoperative mechanical ventilation in elderly patients.Methods PubMed,Web of Science,the Cochrane Library,CNKI,Wan Fang and VIP databases were searched to collect randomized controlled trials(RCTs)of PCV-VG for intraoperative mechanical ventilation in aged patients from inception to January 31,2022.Literature screening,data extraction and assessment of the risk bias were undertaken by two authors independently,and then,meta-analysis was performed by using the software Review Manager 5.4.Results Twelve RCTs were finally included,involving 749 patients,374 in PCV-VG group and 375 in the control group.There were no significant differences in arterial oxygen pressure(PaO_(2))(MD=5.32 mmHg,95%CI-0.55 to 11.18,P=0.08),arterial carbon dioxide pressure tension(PaCO_(2))(MD=0.12 mmHg,95%CI-0.18 to 0.41,P=0.43)between the two groups during intraoperative mechanical ventilation.Compared with the control group,peak airway pressure(Ppeak)was significantly decreased(MD=-3.31 cmH_(2)O,95%CI-4.53 to-2.09,P<0.001),and pulmonary dynamic compliance(Cdyn)was significantly improved(MD=3.85 ml/cmH_(2)O,95%CI 2.46 to 5.25,P<0.001)in the PCV-VG group during intraoperative mechanical ventilation.There was no significant differences in the mean arterial pressure(MAP)(MD=-0.22 mmHg,95%CI-1.45 to 1.01,P=0.72)between the two groups during intraoperative mechanical ventilation.Conclusion PCV-VG decreases the Ppeak and improves Cdyn during intraoperative mechanical ventilation in elderly patients without affecting PaO_(2),PaCO_(2),and MAP.