肺保护性通气策略对俯卧位脊柱手术患者呼吸参数影响的meta分析

Meta analysis on effect of lung-protective ventilation strategies on respiratory parameters in patients undergoing prone spinal surgery

目的系统评价肺保护性通气策略对俯卧位脊柱手术患者呼吸参数的影响。方法通过检索中国知网、维普资讯中文期刊服务平台、中国生物医学文献服务系统、万方医学网、Embase、PubMed、Cochrane临床试验中心注册库等数据库,纳入有关肺保护性通气策略对俯卧位脊柱手术患者呼吸参数影响的随机对照试验(RCT),检索年限为建库至2021年12月,使用RevMan5.3软件进行meta分析。结果最终纳入15篇RCT文献,共864例患者,其中肺保护性通气组(试验组)432例,常规通气组(对照组)432例。试验组患者术中氧合指数(OI)、动脉血二氧化碳分压均明显高于对照组,气道峰压(Ppaek)明显低于对照组,差异均有统计学意义[均数差=19.42、1.64、-3.33,95%可信区间(95%CI):7.03~31.82、0.12~3.16、-5.03~-1.64,P=0.0020、0.0300、0.0001];两组患者肺顺应性、术后肺部并发症发生率、肺外并发症发生率比较,差异均无统计学意义(均数差/优势比=3.19、0.68、1.00,95%CI:-2.35~8.73、0.41~1.12、0.36~2.77,P=0.2600、0.3100、0.9900)。结论脊柱手术中肺保护性通气策略可改善患者术中氧和,减轻气道压力损伤,但可能存在相应的通气不足,术后并发症发生率未见明显差异。

Objective To systematically evaluate the effects of lung-protective ventilation strategies on the respiratory parameters in the patients undergoing prone spinal surgery.Methods The databases of CNKI database,Chinese Science and Technology Periodical Database,Chinese Biomedical Literature Database,Wanfang Medicne network,Embase,PubMed,Cochrane Central Register of Controlled Trials(CENTRAL),etc.were retrieved to obtain the randomized controlled trials(RCTs)on the effects of lung-protective ventilation strategies on the respiratory parameters in the patients undergoing prone spinal surgery.The retrieval period was from the date of database establishment to December 2021,and the meta analysis was performed by using RevMan 5.3 statistical software.Results Fifteen RCTs with 864 patients were included,including 432 cases in the lung-protected ventilation group and 432 cases in the conventional ventilation group.The intraoperative oxygenation index(OI)and partial pressure of arterial carbon dioxide(PaCO 2)in the lung-protected ventilation group were significantly higher those in the conventional ventilation group,the peak airway pressure(Ppaek)was significantly lower than that in the conventional ventilation group,and the differences were statistically significant[MD=19.42,1.64,-3.33;95%CI:7.03-31.82,0.12-3.16,(-5.03)-(-1.64),P=0.0020,0.0300,0.0001].There was no statistically significant difference in the lung compliance(Cdyn),incidence rates of postoperative pulmonary complications and extrapulmonary complications between the two groups[MD=3.19,0.68,1.00;95%CI:(-2.35)-8.73,0.41-1.12,0.36-2.77,P=0.2600,0.3100,0.9900].Conclusion The lung-protective ventilation strategy in spinal surgery can improve intraoperative oxygenation of the patients,reduce the airway pressure injury,but the corresponding hypoventilation may exist and postoperative complication occurrence rate has no obvious difference.