俯卧位通气对重症肺炎患者氧合影响的Meta分析  

Meta analysis of observing prone position ventilation role in the oxygenation of severe pneumonia patients

作　　者：杜玉明[1] 李岩[1] 孙荣青[1] 袁博[1] 高敏[1] 王丽蕊[1] Du Yuming;Li Yan;Sun Rongqing;Yuan Bo;Gao Min;Wang Lirui(Department of Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, Chin)

机构地区：[1]郑州大学第一附属医院重症医学科,河南郑州450000

出　　处：《中华危重病急救医学》2018年第4期327-331,共5页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划项目（201602095）;国家临床重点专科建设项目（2011-873）

摘　　要：目的评价俯卧位通气对重症肺炎患者氧合改善的临床疗效。方法用计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普等数据库，自建库到2017年12月10日所有公开发表的，关于重症肺炎患者俯卧位通气氧合状况的随机对照试验（RCT），并通过纳入文献的参考文献进行引证检索。按照纳入和排除标准筛选文献，并进行文献质量评价，使用RevMan 5.1软件对数据进行Meta分析。结果共纳入12篇文献，中文文献11篇、英文文献1篇，均为单中心RCT研究，共650例患者。10篇文献显示，俯卧位通气可显著提高患者血氧分压〔加权均数差（WMD）=9.93，95%可信区间（95%CI）=2.92-16.95，P=0.006〕，但各研究间存在一定的发表偏倚。7篇文献显示，俯卧位通气可显著降低患者血二氧化碳分压（WMD=9.99，95%CI=1.81-18.18，P=0.02），但各研究间存在一定的发表偏倚。7篇文献显示，俯卧位通气可显著提高患者氧合指数（WMD=31.22，95%CI=26.06-36.39，P〈0.00001），各研究间存在发表偏倚。2篇文献显示，俯卧位通气可显著提高患者血氧饱和度（WMD=2.12，95%CI=1.24-3.00，P〈0.00001），2篇文献发表偏倚不大。结论俯卧位通气可以有效改善重症肺炎患者的氧合。ObjectiveTo systematically evaluate the clinical effect of prone position mechanical ventilation on the improvement of oxygenation in patients with severe pneumonia.MethodsPubmed, Embase, Cochrane Library, CNKI, Wanfang Data and VIP database were searched from the time of database built up until December 10th, 2017. All the published randomized controlled trials （RCTs） about the effects of prone position ventilation on the oxygenation of severe pneumonia patients were screened, and were confirmed by the literature reference citation retrieval. Inclusion and exclusion criteria had been used to review and rank the literature. After evaluating the quality of included studies, the data was extracted from RCTs and given a Meta-analysis using RevMen 5.1.ResultsTwelve RCTs with 650 cases were included. Eleven of them were Chinese literature while 1 was in English. Ten studies showed that the prone position ventilation had a significant influence on improving partial pressure of oxygen [weighted mean difference （WMD） = 9.93, 95% confidence interval （95%CI） = 2.92-16.95, P = 0.006], publication bias was found in these studies. Seven studies showed that the prone position ventilation had a significant influence on partial pressure of carbon dioxide （WMD = 9.99, 95%CI = 1.81-18.18, P = 0.02）, publication bias was found in these studies. Seven studies showed that the prone position ventilation had a significant influence on oxygenation index （WMD = 31.22, 95%CI = 26.06-36.39, P 〈 0.00001）, publication bias was found in these studies. Two studies showed that the prone position ventilation had a significant influence on oxygen saturation of blood （WMD = 2.12, 95%CI = 1.24-3.00, P 〈 0.00001）, no publication bias was found in these studies.ConclusionProne position ventilation can effectively improve the patients＇ oxygenation index, partial pressure of oxygen, and oxygen saturation of blood, and reduce the partial pressure of carbon dioxide.

关 键 词：肺炎 重症 俯卧位通气 氧合 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]