声门下吸引对呼吸机相关肺炎发病率的影响：Meta分析  

Subglottic secretion drainage for preventing ventilator-associated pneumonia： a Meta-analysis

作　　者：郭兰骐[1] 杨毅[1] 郭凤梅[1] 刘玲[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院ICU,东南大学医学院,南京210009

出　　处：《中华急诊医学杂志》2012年第6期592-596,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省自然科学基金（BK2008298）;江苏省“科教兴卫”医学重点学科项目[KJXW11（3）]

摘　　要：目的评估声门下吸引对降低呼吸机相关肺炎（ventilator associated pheumonia，VAP）发病率及患者病死率有效性的影响。方法收集1991年至2010年20年的随机对照研究（randomized controlled trials，RCT），将其中需要机械通气的患者分为两组，一组为声门下引流组，即患者的人工气道带有声门下吸引；另一组则为非声门下引流组，即应用标准气管插管者，观察两组患者呼吸机相关肺炎的发病率及病死率。所得研究数据通过RevMan4．3软件进行统计、分析。结果共7篇RCT研究符合纳入标准，共搜集1647例，声门下引流组（796例）VAP发病率较非声门下引流组（851例）低，提示声门下吸引能明显降低呼吸机相关肺炎的发病率（OR=0．45，95％置信区间：0．32—0．63），尤其能降低早发型VAP的发病率，但对患者病死率的影响则不明显（OR=1．03，95％置信区间：0．75—1．41）。结论对于预期机械通气时间超过48h的患者，声门下吸引能有效降低呼吸机相关肺炎的发病率，但并不改善患者病死率。Objective To assess the efficacy of subglottic secretion drainage for preventing ventilator- associated pneumonia. Methods Data of relevant randomized controlled trials （RCT） from January 1991 to June 2010 were collected, and data were split into two groups, namely draining group and non-draining group. Meta analysis of ventilator-associated pneumonia was carried out for finding the incidence and mortality in patients with mechanical ventilation using the methods recommended by the Cochrane Collaboration. Results Seven RCTs met the inclusion criteria and 1647 patients were enrolled. Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia （ OR = 0.45, 95% confidence interval [ CI] ： 0. 32 -0. 63 ）, primarily by reducing early-onset pneumonia. But the mortalities of ventilator associated pneumonia were not significantly different between the two groups （ OR = 1.03, 95% confi dence interval [ CI] ： 0. 75 - 1.41 ）. Conclusions Subglottic secretion drainage appeared effective in preventing ventilator associated pneumonia among patients expected to require 〉 48 hours of mechanical ventilation, but the mortality was unchanged.

关 键 词：声门下吸引 机械通气 呼吸机相关肺炎 发病率 病死率 META分析 RCT 肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]