镀银气管导管对呼吸机相关性肺炎影响的荟萃分析  

Meta-analysis of effect of silver-coated endotracheal tubes on prevention of ventilator-associated pneumonia

作　　者：刘贤亮[1] 谭景予[1] 陈锦秀[1] 张敏[1] 张文霞[1] 黄玉珊[2] 

机构地区：[1]福建中医药大学护理学院,福建福州350108 [2]井冈山大学循证医学研究中心,江西吉安343009

出　　处：《中华医院感染学杂志》2012年第10期2039-2043,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(81102629)

摘　　要：目的评价镀银气管导管,对预防机械通气患者呼吸机相关性肺炎(VAP)的效果。方法电子检索Cochrane图书馆、PubMed、EMbase、ScienceDirect、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库等,各数据库检索时间均从创建到2011年8月;纳入镀银气管导管对预防机械通气患者VAP效果的随机对照试验(RCT);采用RevMan5软件进行荟萃分析,对于无法转换合并的数据,采用描述性分析。结果共纳入3个RCT、2127例患者,文献异质性较小;荟萃分析结果表明,镀银气管导管可显著降低VAP的发生率[固定效应模型,OR=0.59,95%CI(0.41,0.84),P=0.005]、死亡率和负面事件等方面两组差异无统计学意义;住院时间、住ICU时间、气管插管时间、临床肺感染指数及呼吸道细菌浓度等指标,由于数据难以转换及难以获取完整数据等原因未能做荟萃分析,只进行描述性分析,显示两组在上述指标方面差异无统计学意义。结论与标准非镀银气管导管相比,镀银气管导管能显著降低机械通气患者VAP的发生率,而对患者死亡率及负面事件发生率等指标无明显改善;需要进行更多设计严格的、多中心、大样本随机对照试验,对镀银气管导管的综合效果进行验证。OBJECTIVE To evaluate the efficacy of silver-coated endotracheal tubes（EETs） in the prevention of ventilator-associated pneumonia（VAP） in the patients undergoing mechanical ventilation.METHODS PubMed,the Cochrane library,EMbase,ScienceDirect,CBM,CNKI,and Wanfang Database were searched through Aug,2011 for randomized controlled trials on the use of silver-coated EETs for the prevention of VAP in MV patients.Meta analysis was performed with RevMan5 software,and descriptive analysis of the data that could not be converted and merged was performed.RESULTS Totally 3 RCT involved,including 2127 patients,and the heterogeneity of the literature was so small（P0.1）;meta-analysis showed that silver-coated EETs were associated with a decreased incidence of VAP [Fixed Effect Model,OR=0.59,95%CI（0.41,0.84）,P=0.005],the differences in the mortality and adverse events were statistically significant;the descriptive analysis showed that the differences in the hospital stay,ICU stay,duration of intubation,the index of clinical pulmonary infections and the bacterial concentration of respiratory tract were not statistically significant because the data could not be converted and the completed data can not be acquired.CONCLUSION Compared to the standard non-coated EETs,silver-coated EETs can significantly decrease the incidence of VAP in the patients undergoing mechanical ventilation,but the death rate and the incidence of adverse events are not improved significantly;the rigorous,multi-center and large sample of randomized control test needs to be designed for the verification of comprehensive effect of silver-coated endotracheal tubes.

关 键 词：镀银气管导管 肺炎 呼吸机相关性 荟萃分析 

分 类 号：R181.32[医药卫生—流行病学]