不同口腔护理液对呼吸机相关性肺炎预防效果的网状Meta分析

Effect of different oral care solutions on ventilator-associated pneumonia prevention:a network meta-analysis

[目的]采用网状Meta分析的方法评价多种常用口腔护理液在预防呼吸机相关性肺炎(VAP)方面的效果,为机械通气病人口腔护理液的选择提供参考。[方法]系统检索中国知网(CNKI)、万方数据库、中国生物文献数据库、Medline数据库、EMbase、Cochrane Library,检索时间均限定为从建库到2015年4月,筛选出机械通气病人口腔护理相关的随机对照研究,并进行文献质量评价,使用WinBUGS 1.43软件和ADDIS1.16.5软件对数据进行网状Meta整合,采用ADDIS软件提供的节点分析进行一致性检验。[结果]共纳入50篇相关文献,涉及14种口腔护理液,文献质量一般,一致性检验显示直接比较与间接比较的结果无明显不一致性。WinBUGS软件和ADDIS软件的运算结果均显示碳酸氢盐、酸性氧化电位水、呋喃西林、高锰酸钾、西吡氯铵、氯己定、碘剂、中药剂、蒸馏水作为口腔护理液较生理盐水在预防VAP发生率方面差异有统计学意义,中药制剂的口腔护理液较碳酸氢钠、李施德林、过氧化氢、三氯生有统计学意义,氯己定较三氯生有统计学差异;排序概率图显示中药制剂、西吡氯铵、呋喃西林、过氧化氢、酸性氧化电位水的效果排序在前5位,生理盐水的效果排最后,高锰酸钾、蒸馏水、氯己定、碘剂、碳酸氢盐、李施德林、三氯生的效果居中。[结论]14种口腔护理液中,中药制剂、西吡氯铵、呋喃西林、过氧化氢、酸性氧化电位水在预防机械通气病人VAP方面的效果较好,但仍需更多高质量、大样本研究进一步证实。

Objective:To evaluate the effect of various oral care solutions on the prevention of ventilator-associated pneumonia(VAP)by network meta-analysis,and to provide references for choosing oral care solution for patients with mechanical ventilation.Methods:CNKI,Wanfang database,Chinese biology database,Medline database,EMbase and Cochrane library were searched systematically from establishment to April 2015,respectively.Related Randomized Controlled Trials(RCTs)on oral care of patients with mechanical ventilation were analyzed and evaluated.WinBUGS 1.43 and ADDIS 1.16.5 were used to mesh the data.And the consistency analysis was performed by ADDIS software.Results:A total of 50 related papers which involved in 14 kinds of oral care solutions were enrolled in this study.The quality of the papers was general.The consistency test showed that there was no obvious inconsistency between the direct and indirect comparison.The calculate results of WinBUGS software and ADDIS software showed that oral care solution,bicarbonate,acid oxidizing potential water,nitrofurazone,potassium permanganate,cetylpyridinium chloride,chlorhexidine,iodine,traditional Chinese medicine,and distilled water were significantly different compared with normal saline in prevention of VAP incidence.Traditional Chinese medicine preparations was statistically significantly different with sodium bicarbonate,Listerine,hydrogen peroxide and triclosan.Chlorhexidine had statistical difference compared with triclosan.Probability diagram showed that the effect of Chinese medicine preparation,cetylpyridinium chloride,nitrofurazone,hydrogen peroxide,and acidic oxidation potential water were the top five.The effect of normal saline was the worst.The effect of potassium permanganate,distilled water,chlorhexidine,iodine,bicarbonate,Listerine,and triclosan were in the middle.Conclusions:Among the 14 oral care solutions,the traditional Chinese medicine preparation,cetylpyridinium chloride,nitrofurazone,hydrogen peroxide,and acid oxidation potential water have a better effect in the prevention of VAP in patients with mechanical ventilation.However it still need more highquality,large sample study to confirm.