支气管肺泡灌洗术治疗儿童大叶性肺炎临床疗效的Meta分析

Meta-analysis of the clinical efficacy of bronchoalveolar lavage in the treatment of children with lobar pneumonia

目的评价支气管肺泡灌洗术(bronchoalveolar lavage,BAL)治疗儿童大叶性肺炎的临床疗效。方法通过计算机检索英文文献数据库PubMed、EMBASE、The Cochrane Library、Web of Science以及中文文献数据库中国知识资源总库(Chinese National Knowledge Infrastructure,CNKI)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(China Biology Medicine,CBM)、中文科技期刊数据库(维普网),纳入自建库至2020年2月3日收录的BAL治疗儿童大叶性肺炎的随机对照试验。根据Cochrane风险偏倚评估工具对纳入文献进行评价。采用Revman 5.4软件进行Meta分析。结果最终纳入24项研究,其中试验(常规治疗联合BAL)组1129例,对照(常规治疗)组1122例。与常规治疗组相比,常规治疗联合BAL组治疗儿童大叶性肺炎的有效率高(OR=3.76,95%CI:2.65~5.31,P<0.05,I^(2)=0,退热时间短(MD=-2.43,95%CI:-2.63~-2.22,P<0.05,I^(2)=91%),咳嗽消失时间短(MD=-3.97,95%CI:-4.96~-2.97,P<0.05,I^(2)=99%),啰音消失时间短(MD=-3.21,95%CI:-3.66~-2.77,P<0.05,I^(2)=98%),住院时间短(MD=-3.91,95%CI:-4.27~-3.55,P<0.05,I^(2)=62%),肺部阴影消失快(MD=-2.41,95%CI:-3.01~-1.84,P<0.05,I^(2)=92%),并发症少(OR=0.34,95%CI:0.19~0.62,P<0.05,I^(2)=0)。对治疗有效率、退热时间、咳嗽消失时间、肺部啰音消失时间、住院时间的纳入文献进行漏斗图分析,结果显示发表偏倚较小。结论常规治疗联合BAL治疗儿童大叶性肺炎,可取得更好的临床疗效及收益。

Objective To evaluate the clinical effect of bronchoalveolar lavage(BAL)on children with lobar pneumonia.Method English literature databases:PubMed,EMBASE,The Cochrane Library,Web of Science and Chinese literature database:Chinese National Knowledge Infrastructure(CNKI),China Science Periodical Database(Wanfang Data),China Biology Medicine(CBM),China Science and Technology Journal Database(VIP)were searched by computer.The literatures of randomized controlled trial related to BAL in the treatment of children with lobar pneumonia from self-built database to February 3,2020 were adopted in this study.The Cochrane risk bias assessment tool built into the software RevMan 5.4 provided by the Cochrane Collaboration was used to evaluate the quality of the included literatures.The software Revman 5.4 was used for statistical analysis.Result Twenty-four studies were included,total 1129 in the experimental(conventional treatment combined with BAL)group and 1122 in the control(conventional treatment)group.The effective rate of conventional treatment combined with BAL group was higher than that in the conventional treatment group[OR=3.76,95%CI:2.65-5.31,P<0.05,I^(2)=0],the time of fever was shorter[MD=-2.43,95%CI:-2.63--2.22,P<0.05,I^(2)=91%],the time of cough disappeared was shorter[MD=-3.97,95%CI:-4.96--2.97,P<0.05,I 2=99%],the time of rale disappearance was shorter[MD=-3.21,95%CI:-3.66--2.77,P<0.05,I^(2)=98%],the time of hospitalization was shorter[MD=-3.91,95%CI:-4.27--3.55,P<0.05,I^(2)=62%],the time of pulmonary shadow disappearance was faster[MD=-2.41,95%CI:-3.01--1.84,P<0.05,I^(2)=92%],the complications were fewer[OR=0.34,95%CI:0.19-0.62,P<0.05,I 2=0].Funnel plot analysis was conducted on the included literatures including treatment effectiveness,fever time,cough disappearance time,rale disappearance time,the time of hospitalization and the results showed that publication bias were small.Conclusion Conventional treatment combined with BAL in the treatment of children with lobar pneumonia can achieve better clinical efficacy and benefits.