经皮旋转扩张气管切开术在重症监护病房临床应用的系统评价  

A systematic review of clinical application of Percu Twist tracheostomy in intensive care unit

作　　者：秦枫[1] 豆欣蔓[1] 牟成华[2] 牛芳[2] 南锐伶[2] 张燕花[2] 董晨明[2] 田金徽[3] 

机构地区：[1]兰州大学第二医院护理部,甘肃730030 [2]兰州大学第二医院ICU,甘肃730030 [3]兰州大学第二医院循证医学中心,甘肃730030

出　　处：《中华危重病急救医学》2014年第12期895-900,共6页Chinese Critical Care Medicine

基　　金：基金项目：甘肃省科学事业费科研项目（QS031-C33-14）;兰州大学中央高校科研基金项目（1zjbky2011-2013）

摘　　要：目的 系统评价经皮旋转扩张气管切开术（PT）对比传统气管切开术（OT）在重症监护病房（ICU）患者中的临床应用效果。方法 通过计算机检索中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库、维普数据库、PubMed、EMBASE、Cochrane Central Register of Controlled Trials（CENTRAL）和Web of Science，纳入在ICU患者中应用PT与OT并对比分析的随机对照临床试验（RCT）。检索时间为自建库起至2014年5月15日。根据纳入、排除标准筛选符合要求的RCT，由2名研究员提取数据并进行质量评价，使用RevMan 5.2软件进行Meta分析。结果 共纳入12篇RCT、893例ICU患者。Meta分析结果显示：PT组在手术时间〔标准差（MD）＝-15.11，95%可信区间（95%CI）＝-17.14～-13.07，P＜0.00001〕、术中出血量（MD＝-17.59，95%CI＝-21.90～-13.28，P＜0.00001）、切口大小（MD＝-2.20，95%CI＝-2.57～-1.82，P＜0.00001）和切口愈合时间（MD＝-3.60，95%CI＝-4.15～-3.05，P＜0.00001）方面均优于OT组，且PT组的切口感染〔比值比（OR）＝0.20，95%CI＝0.10～0.44，P＜0.0001〕和皮下气肿/纵隔气肿（OR＝0.22，95%CI＝0.10～0.47，P＜0.0001）发生率均明显低于OT组。漏斗图提示12个研究间可能存在发表偏倚。结论 PT在ICU临床应用效果较好，并发症发生率低，值得推广。鉴于纳入研究样本量小、质量低，推荐今后开展大样本量、高质量的RCT进一步证实其疗效。Objective To evaluate the effectiveness of Percu Twist （PT） tracheostomy comparing with that of operative tracheostomy（OT）in intensive care unit（ICU）. Methods Related data were retrieved from CBM,CNKI,Wanfang Data,VIP,PubMed,EMBASE,CENTRAL,and Web of Science from the time of their establishment to May 15th 2014,and the data of randomized controlled trials（RCTs）concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software. Results A total of 12 RCTs were identified,and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time〔mean difference （MD）=-15.11,95% confidence interval（95%CI）=-17.14 to -13.07,P〈0.000 01〕,reduce the volume of blood loss（MD=-17.59,95%CI=-21.90 to-13.28,P〈0.000 01）,reduce the size of incision（MD=-2.20, 95%CI=-2.57 to -1.82,P〈0.000 01）,shor ten the time of healing（MD=-3.60,95%CI=-4.15 to -3.05, P〈0.000 01）,and reduce complications such as infection of the wound〔odds ratio（OR）=0.20,95%CI=0.10-0.44,P〈0.000 1〕and cutaneous emphysema/mediastinal emphysema（OR=0.22,95%CI=0.10-0.47,P〈0.000 1）compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches. Conclusions PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality,further clinical use is warranted for a better assessment.

关 键 词：经皮旋转扩张气管切开术 气管切开术 重症监护病房 出血量 切口愈合时间 并发症 

分 类 号：R473[医药卫生—护理学]