呼气末正压设定对急性呼吸窘迫综合征患者病死率影响的Meta分析  

A meta-analysis of effects of high PEEP versus low PEEP upon mortality in patients with acute respiratory distress syndrome

作　　者：李明[1] 张倩[1] 陈小东[1] 

机构地区：[1]复旦大学附属华山医院呼吸科,上海200040

出　　处：《中华医学杂志》2009年第40期2831-2834,共4页National Medical Journal of China

摘　　要：目的评价呼气末正压（PEEP）设定对急性呼吸窘迫综合征（ARDS）患者病死率的影响。方法在Medline、Embase、WebofScience、CENTRAL和中国生物医学文献数据库中检索比较高PEEP和低PEEP对ARDS患者病死率影响的随机对照试验，没有限定时间，入选标准为患者数〉10例，符合当时的ARDS和急性肺损伤诊断标准，必须使用有创机械通气并且高PEEP与低PEEP之间差异有统计学意义，必须有住院期问的病死率统计。对符合标准的文献进行Meta分析。结果5篇文献（包含2447例患者）符合人选标准，住院病死率高PEEP组为34．2％（415／1215），低PEEP组为37．7％（464／1232），合并相对危险度（RR）为0．91，95％可信区间（CI）为0．82～1．01，P=0．07。去除没有使用低潮气量通气策略的试验进行敏感性分析，合并RR为0．94，95％CI为0．84～1．05，P=0．25，与剔除前结论基本一致。漏斗图和Begg秩相关法检验表明无明显发表偏倚（x^2=8．26，P=0．09）。结论使用高PEEP和低PEEP通气策略治疗，ARDS患者的住院病死率相似。Objective To evaluate the effects of high PEEP versus low PEEP upon mortality in patients with acute respiratory distress syndrome （ARDS）. Methods The databases Medline, Embase, Web of Science, CENTRAL and CBM （ Chinese Bio-Medical Literature ＆ Retrieval System） were retrieved by using the key words ARDS, ALI, acute hypoxemic respiratory failure, acute respiratory distress syndrome, adult respiratory distress syndrome, respiratory failure, systemic inflammatory response syndrome, non-cardiogenic pubnonary edema, ventilation, PEEP, and positive end expiratory pressure, so as to search the materials about the randomized controlled trials comparing the mortality of ARDS or ALI treated by high PEEP and low PEEP. Study reports were included if they： （1） enrolled over 10 patients; （2） enrolled adult human ARDS or ALI subjects treated with mechanical ventilation; （3） included high PEEP and low PEEP with significant differences; and （4） included hospital mortality. Results Five documents about randomized controlled clinical trials, including 2447 patients, met the enrollment criteria. The hospital mortalities of high PEEP and low PEEP groups were 34. 2% （415/1215） and 37. 7% （464/ 1232） respectively （RR = 0. 91,95% CI： 0. 82 - 1.01, P = 0. 07 ） . Sensitive analysis confirmed the nonexistence of differences in hospital mortality between these two groups （RR = 0. 94, 95% CI： 0. 84 - 1.05, P = 0. 25 ）. Neither funnel plot nor rank correlation test regarding hospital mortality indicated the existence of publication bias （ x^2 = 8.26, P = 0. 09 ） . Conclusion The use of high or low PEEP in oxygenation function does not affect hospital mortality in ARDS patients.

关 键 词：呼吸窘迫综合征 成人 正压呼吸 META分析 

分 类 号：R686[医药卫生—骨科学]