间歇声门下滞留物吸引对呼吸机相关性肺炎影响的Meta分析  

Meta- analysis of effects of intermittent subglotfic secrelion drainage on venlilator- associated pnetmonia

作　　者：吴晓琴[1] 宋锦平[2] 苏霞[3] 

机构地区：[1]徐州医学院第二附属医院感染管理科,221006 [2]四川大学华西医院护理部 [3]吉林大学临床医学院护理系

出　　处：《中国实用护理杂志》2012年第29期68-70,共3页Chinese Journal of Practical Nursing

基　　金：徐州科技情报局中标课题（XF10C031）

摘　　要：目的评价可吸引导管进行间歇声门下吸引滞留物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、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2012年3月；纳入声门下吸引对预防机械通气患者VAP效果的随机对照实验（RCT）；采用RevMan5软件进行Meta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5个RCT，683例患者。Meta分析结果，使用可吸引的气管导管进行间歇声门下吸引可显著降低VAP的发生率，死亡率和负面事件等方面2组间差异无统计学意义；住院时间、住ICU时间、气管插管时间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Meta分析，只进行描述性分析。结论与普通气管导管相比，可吸引气管导管进行间歇声门下吸引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、大样本随机对照实验对可吸引气管导管的综合效果进行验证。Objective To study the effects of intermittent subglottic secretion drainage（SSD）with an endotracheal tube on incidience of ventilator- associated pneumonia（VAP）. Methods We searched com- puterized databases, including Cochrane library, Pubmed, EMbase, CBM, CNKI, Wanfang and some relevant databases from initializing to March 2012, extracting data about subglottic secretion drainage（SSD）with an en- dotracheal tube on incidence of VAP using RCT. The data had Meta- analysis by software RevMan5, and to those data which could not be conversed or merged, they underwent descriptive analysis. Restdts Weidenti- fled 5 randomized clinical trials that met the inclusion criteria with a total of 683 randomized patients. In Meta- analysis, the overall risk ratio for ventilator- associated pneumonia was decreased significantly by in- termittent subglottic secretion drainage with an endotracheal tube. There was no significant difference on adverse events or on hospital or intensive care unit mortality. Databases, including ICU and hospital LOS, dura- tion of endotracheal catheterization, bacteria concentration, which were difficult to be conversed and obtained full data, they underwent a descriptive research. Conclusions Compared with the common endotracheal tubes, the use of endotracheal tubes with subglottic secretion drainage is effective for prevention of ventilatoras- sociated pneumonia. But it has no effect on adverse events or on hospital or intensive care unit mortality. So large sample RCTs with multiply- center should be carried out to assess the effect of the use of SSD.

关 键 词：可吸引气管导管 声门下吸引 呼吸机相关性肺炎 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]