气管切开时机对颈髓损伤患者预后影响的Meta分析  

Meta analysis of effect of tracheostomy timing on prognosis of patients with cervical spinal cord injury

作　　者：王严[1] 范德红 滕海军 谢东[1] 李培 郭志良 鲁海江 Wang Yan;Fan Dehong;Teng Haijun;Xie Dong;Li Pei;Guo Zhiliang;Lu Haijiang(Clinical Medical College,Weifang Medical University,Weifang 261000,China)

机构地区：[1]潍坊医学院临床医学院,山东省潍坊市261000 [2]解放军第八十几医院脊柱二科

出　　处：《中华创伤杂志》2018年第8期696-703,共8页Chinese Journal of Trauma

摘　　要：目的评价早期气管切开与晚期气管切开对颈髓损伤患者预后的影响，为颈髓损伤气管切开时机选择提供循证依据。方法检索PubMed数据库、Embase生物医学数据库、Medline数据库、Cochrane图书馆、中国生物医学文献服务系统（CBM）、中国期刊全文数据库（CNKI）及维普期刊数据库中关于气管切开时机对颈髓损伤患者预后影响的研究文献，检索时限由建库至2018年3月。按照制定的纳入和排除标准对检索到的文献进行筛选。根据纽卡斯尔-渥太华量表（Newcastle—Ottawa scale，NOS）严格进行文献质量评价。利用RevMan5．3软件进行Meta分析，比较颈髓损伤患者早期与晚期气管切开在机械通气时间、ICU住院时间、肺部感染率、并发症发生率及病死率方面差异有无统计学意义。结果最终纳入8篇队列研究文献，共466例患者，其中早期气管切开组241例，晚期气管切开组225例。经NOS评分均判定为高质量研究。早期气管切开与晚期气管切开在总机械通气时间（MD=-12．28，95％CI-20．09～-4．47，P〈0．01）、气管切开后机械通气时间（MD=-9．92，95％CI-14．27～-5．57，P〈0．01）、总ICU住院时间（MD=-10．30，95％CI-17．12～-3．47，P〈0．01）、气管切开后ICU住院时间（MD=-5．79，95％CI-6．53～-5．05，P〈0．01）、并发症发生率（RR=0．56，95％CI0．38-0．83，P〈0．01）、病死率（RR=0．34，95％CI0．15～0．78，P〈0．05）等方面差异均有统计学意义，在总肺部感染率（RR=0．77，95％CI0．57～1．05，P〉0．05）、气管切开后肺部感染率（RR=0．80，95％CI0．51～1．26，P〉0．05）方面差异无统计学意义。结论早期气管切开可缩短颈髓损伤患者机械通气时间、ICU住院时间，降低并发症发生率和病死率，但不能降低肺部感染率。Objective To evaluate the effects of early tracheostomy and late tracheostomy on the prognosis of patients with cervical spinal cord injury, so as to provide evidence based guidance for the timing of tracheostomy. Methods Relevant literatures studying the timing of traeheostomy in patients with cervical spinal cord injury were searched in PubMed, Embase, Medline, Cochrane Library, Chinese Biological Medical Literature database （CBM）, China National Knowledge Infrastructure database （CNKI）, and VIP journal database with time range from journal establishment to March 2018. The retrieved articles were screened according to the inclusion and exclusion criteria. The article quality was rigorously evaluated according to the Newcastle-Ottawa scale （NOS）. Meta analysis was conducted using Review Manager 5. 3 software to compare the mechanical ventilation time, ICU stay, incidence of pneumonia, incidence of complications, and mortality between early and late tracheostomy in patients with cervical spinal cord injury. Results A total of eight articles of cohort study including 466 patients were included , with 241 patients in the early tracheostomy group and 225 patients in the late tracheostomy group. The eight articles were all determined as high quality studies according NOS. The results of Meta analysis showed that there were significant differences between the two groups in terms of the total mechanical ventilation time （MD = - 12.28, 95% CI - 20.09- - 4.47, P 〈 0.01 ） , post traeheostomy mechanical ventilation time （MD = -9.92, 95%CI -14.27--5.57, P〈0.01）, total ICU stay （MD = - 10.30, 95%CI - 17. 12-- 3.47,P 〈 0.01）, post tracheostomy ICU stay （MD = - 5.79, 95% CI - 6.53- - 5.05, P 〈 0.01 ） , incidence of complications （ RR = 0.56, 95% C10. 38-0.83, P 〈 0. 01 ） , and mortality （RR =0.34, 95% CI 0. 15-0.78, P 〈 0.05 ）. However, no significant differences were detected between the two groups in the incidence of total pneumonia （RR = 0.77, 95% CI 0. 57-1.05, P 〉 0.05

关 键 词：气管切开术 脊髓损伤 预后 META分析 

分 类 号：R651.2[医药卫生—外科学]