锥形气囊气管导管与传统气管导管对于预防呼吸机相关肺炎效果的Meta分析

Conical balloon endotracheal catheters versus conventional endotracheal catheters in the prevention of ventilator-associated pneumonia:A meta-analysis

目的系统评价锥形气囊气管导管与传统气囊气管导管对机械通气患者呼吸机相关性肺炎(VAP)发生率及其他结局指标的影响。方法系统性检索Cochrane Library、Embase、PubMed、中国知网、维普数据库、中国生物医学文献数据库、万方数据库等,并辅以人工手动检索,严格按照入排标准筛选文献,对符合要求的研究进行质量评价并提取资料,采用RevMan 5.3软件进行Meta分析。结果共纳入7篇文献(共8组研究),共3858例患者。与传统气囊气管导管相比,锥形气囊气管导管可以降低VAP发生率(OR=0.52;95%CI:0.39~0.68;P<0.01),降低临床肺部感染评分(CPIS),降低机械通气时间及ICU住院时间(P均<0.01)。结论对于机械通气患者,采用锥形气囊气管导管可以降低VAP发生率,但由于纳入的随机对照试验数量较少、质量欠佳,需要纳入更多高质量的随机对照试验进一步证实。

OBJECTIVE To systematically evaluate the effect of tapered cuff endotracheal tubes and conventional endotracheal balloon catheters on the incidence of ventilator-associated pneumonia(VAP)and other outcome indicators in patients with mechanical ventilation.METHODS Literatures in Cochrane Library,Embase,PubMed,CNKI,VIP,CBM and Wanfang database were searched,and manual retrieval was used to screen the literatures strictly according to the inclusion criteria.Quality evaluation and data extraction were conducted for the qualified studies,and meta-analysis was conducted by using RevMan5.3 software.RESULTS A total of 7 studies(8 sets of intervention and control groups)were included,with 3858 patients.Compared with traditional balloon endotracheal tube,tapered cuff endotracheal tubes can significantly reduce the incidence of VAP(OR=0.52;95%CI:0.39-0.68;P<0.01),clinical pulmonary infection score(CPIS),mechanical ventilation time and length of intensive care unit(ICU)stay(P<0.01).CONCLUSION In patients with mechanical ventilation,the use of tapered cuff endotracheal tubes can significantly reduce the incidence of VAP.But due to the small number and poor quality of included randomized controlled trials(RCTs),more high-quality RCTs should be included for further confirmation.