高呼气末正压通气结合小潮气量对急性肺损伤／急性呼吸窘迫综合征患者预后影响的荟萃分析  

The influence of high positive end-expiratory pressure ventilation combined with low tidal volume on prognosis of patients with acute lung injury/acute respiratory distress syndrome： a Meta-analysis

作　　者：杨君[1] 刘飞[1] 朱曦[1] 

机构地区：[1]北京大学第三医院ICU,100191

出　　处：《中国危重病急救医学》2011年第1期5-9,共5页Chinese Critical Care Medicine

摘　　要：目的 系统评价高呼气末正压（PEEP）与低PEEP机械通气对急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）患者预后的影响.方法 通过检索美国〈医学索引〉、荷兰〈医学文摘〉、Cochrane临床试验数据库、中国生物医学文献数据库（CBM）和中国期刊网全文数据库（CNKI）等文献数据库,全面收集全世界范围内高PEEP与低PEEP治疗ALI/ARDS患者的随机对照试验（RCT）,提取文献中的相关资料和评估方法学质量,而后采用Cochrane协作网RevMan 5.0软件对资料进行荟萃分析（Meta分析）.结果 最终纳入6个RCT共2484例ALI/ARDS患者.A亚组的3个RCT中试验组采用了高PEEP（相对于对照组）,对照组采用了低PEEP（相对于试验组）,两组均采用了小潮气量（6 ml/kg）通气;B亚组的3个RCT中试验组采用了高PEEP加小潮气量,对照组采用了低PEEP加传统潮气量通气.合并结果显示,B亚组中高PEEP加小潮气量通气策略可以降低患者的28 d病死率[Peto比值比（OR）=0.40,95%可信区间（95%CI）0.22～0.72,P=0.003]和气压伤发生率（OR=0.20,95%CI 0.05～0.82,P=0.02）;A亚组中,两组患者的28 d病死率（OR=0.86,95%CI 0.72～1.02,P=0.08）和气压伤发生率（OR=1.19,95%CI 0.89～1.58,P=0.25）差异无统计学意义.结论 高PEEP加小潮气量通气可以改善ALI/ARDS患者的28 d病死率和气压伤发生率,单独高PEEP的作用需要进一步评价.Objective To compare the effects of high and low positive end-expiratory pressure （PEEP） levels on prognosis of patients with acute lung injury/acute respiratory distress syndrome （ALI/ARDS）. Methods The data in PubMed, EMbase, Cochrane Library, CBM and CNKI were retrieved. All randomized controlled trials （RCTs） of treatment of ALI/ARDS with PEEP with high or low level were included. Study selection and assessment, data collection and analyses were undertaken by two independent reviewers. Meta-analyses were done using Cochrane Collaboration＇s RevMan 5.0 software.Results Six RCTs, involving a total of 2 484 patients of ALI/ARDS were included in the review. According to ventilation strategy, all trials were divided into subgroup A （high PEEP＋low tidal volume of 6 ml/kg vs.low PEEP＋low tidal volume） and subgroup B （high PEEP＋low tidal volume vs. low PEEP＋traditional tidal volume）. In subgroup B, there were three RCTs, and high PEEP was found to be associated with a lower 28-day mortality [odds ratio （OR）=0. 40, 95% confidence interval （95%CI） 0.22 -0.72, P=0.003]and a lower barotraumas （OR = 0.20,95%CI 0.05 - 0.82, P = 0.02） in patients with ALI/ARDS. In subgroup A, there were three RCTs, and it was found that the differences in 28-day mortality （OR=0.86,95%CI 0.72 - 1.02, P = 0.08） and barotraumas （OR = 1.19, 95%CI 0.89 - 1.58, P= 0.25） were not significant. Conclusion As compared with conventional ventilation, high PEEP and low tidal volume ventilation are associated with improved survival and a lower rate of barotrauma in patients with ALI/ARDS.It is necessary to further confirm the role of high PEEP only in the ventilation strategy in patients with ALI/ARDS.

关 键 词：呼气末正压 急性呼吸窘迫综合征 急性肺损伤 随机对照临床试验 系统评价 

分 类 号：R563.8[医药卫生—呼吸系统]