两种半卧体位对预防呼吸机相关性肺炎有效性和安全性的荟萃分析  

Two semi-recumbent positions to prevent ventilator-associated pneumonia:A systematic review and meta-analysis

作　　者：高云[1] 李文哲 于湘友[1] 王毅[1] 杜欣欣[1] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830011

出　　处：《西部医学》2018年第1期35-39,共5页Medical Journal of West China

基　　金：国家自然科学基金(81160232)

摘　　要：目的分析两种半卧体位(25°~30°与45°)预防成人机械通气患者呼吸机相关性肺炎(VAP)的有效性和安全性,并评价25°~30°是否较45°更有优势。方法通过计算机和手工检索的方法收集自1980年1月~2017年5月国内外对比床头抬高25°~30°与45°的随机对照研究(RCT),探讨床头抬高角度与VAP发生率及其他临床预后之间的关系。结果共6项RCT符合纳入条件,使用随机效应模型对6项随机试验(636例患者)进行荟萃分析,结果显示在降低VAP发生率上,床头抬高25°~30°与45°相比没有发现显著差异[相对危险度(RR)=1.30;95%可信区间(CI)0.91,1.86;P=0.99;I2=0%]。共纳入3篇观察性研究,显示床头抬高25°~30°可能有更低的压疮风险,更好的临床依从性。结论在机械通气的成人重症患者中,与床头抬高45°相比,床头抬高25°~30°在预防VAP发生率上以及其他临床并发症上没有显著差异,但可以提高临床依从性和降低压疮的风险。Objective To evaluate the efficacy and safety of two different angles of head of bed elevation （25°~30° and 45°） in the prevention of ventilatorassociated pneumonia （VAP） in adult patients with mechanical ventilation and to evaluate whether 25°~30° semirecumbent position is superior to 45°head of bed evaluation. Methods Randomized controlled trials （RCTs） on 25°~30° and 45° were performed from January 1, 1980 to May 1, 2017 at home and abroad, and collected by electronic and manual retrieval. The relationship of the angle of bed head evaluation and VAP incidence and other clinical prognosis were observed. Results 6 RCTs were eligible for inclusion, and 6 randomized trials （636 patients） were used for metaanalysis using the random effects model. The results showed that there was no significant difference between 25° to 30° of head evaluation in reducing the incidence of VAP ,compared with 45° [relative risk （RR）=1.30; 95% confidence interval （CI） 0.91, 1.86; P=099; I2=0%]. Three observational studies were performed to show that bedside elevation of 25° to 30° might have a lower risk of pressure ulcer, better clinical compliance. Conclusion In adult mechanical ventilation critically ill patients, compared with the bedside elevation of 45 degrees, the bedside elevation of 25°~30°, there is no significant difference in preventing the incidence of VAP and other clinical complications, but it can improve the clinical compliance and reduce the risk of pressure ulcer.

关 键 词：半卧位 机械通气 呼吸机相关性肺炎 压疮 

分 类 号：R563.1[医药卫生—呼吸系统]