咳痰机用于机械通气病人呼吸道清理效果的系统评价

Systematic evaluation on the respiratory tract cleaning effect of expectoration machine in patients undergoing mechanical ventilation

[目的]系统评价咳痰机在机械通气病人呼吸道清理中的应用效果。[方法]手动检索中国和美国临床试验注册中心官网,计算机检索PubMed、Web of Science、Cochrane Library、EMBASE、CBM、中国知网和万方数据库,收集建库至2018年1月关于采用咳痰机清理机械通气病人呼吸道的随机对照试验。由2名研究者根据纳入及排除标准筛选文献并提取资料,依据Cochrane Handbook评价文献质量,使用Stata12.0软件进行Meta分析或仅做描述性分析。[结果]共纳入6项随机对照试验。描述性分析结果显示:干预组医院感染情况及肺部感染情况优于对照组,低氧血症发生率低于对照组,氧分压值高于对照组,二氧化碳分压值低于对照组,降钙素原、通气失败率及再插管率低于对照组(P<0.05)。Meta分析结果显示:干预组病人氧合指数[SMD=1.88,95%CI(0.79,2.97),P=0.001]、肺顺应性[SMD=0.95,95%CI(0.65,1.25),P=0.00]优于对照组,机械通气时间短于对照组[SMD=-2.21,95%CI(-3.74,-0.67),P=0.005]。[结论]现有证据表明:咳痰机能有效协助机械通气病人清除呼吸道分泌物,改善机体氧合及肺顺应性,缩短病人机械通气时间,促进病人恢复。

Objective:To systematically evaluate the application effect of expectoration machine in respiratory tract cleaning for patients undergoing mechanical ventilation.Methods:The official websites of China and USA Clinical Trials Registry were manually searched.And databases including PubMed,Web of Science,Cochrane Library,EMBASE,CBM,CNKI and Wanfang Data were searched by computers.Randomized controlled trials on using expectoration machine to cleaned respiratory tract for patients undergoing mechanical ventilation were collected from inception to January 2018.Two researchers screened and extracted documents according to inclusion and exclusion criteria.The qualities of documents were evaluated by Cochrane Handbook.Data was analyzed with Meta-analysis by Stata 12.0 software or only with descriptive analysis.Results:A total of 6 randomized controlled trials were included.Descriptive analysis showed that the hospital infection and pulmonary infection in intervention group was better than those in control group,the incidence of hypoxemia was lower than that in control group,the partial pressure of oxygen was higher than that in control group,the partial pressure of carbon dioxide,the procalcitonin,the ventilation failure rate and the reintubation rate were lower than those in control group(P<0.05).Meta-analysis showed that the oxygenation index[SMD=1.88,95%CI(0.79,2.97),P=0.001],lung compliance[SMD=0.95,95%CI(0.65,1.25),P=0.00]of patients in the intervention group were better than those of the control group,and the duration of mechanical ventilation was shorter than that of the control group[SMD=-2.21,95%CI(-3.74,-0.67),P=0.005].Conclusions:Present evidences showed that expectoration machine could effectively assist of cleaning respiratory tract secretion of patients undergoing mechanical ventilation,improve oxygenation and lung compliance,shorten mechanical ventilation time,and promote recovery of patients.