俯卧位通气治疗急性呼吸窘迫综合征患者临床不良事件的Meta分析  

Clinical Adverse Events of Prone Position in Ventilated Patients with Acute Respiratory Distress Syndrome:A Meta-analysis

作　　者：岳伟岗[1] 张莹[1] 蒋由飞 袁鹏[1] 尹瑞元 冯鑫 张志刚[1] 张彩云[2] 田金徽[3] YUE Weigang;ZHANG Yin;JIANG Youfei;YUAN Peng;YIN Ruiyuan;FENG Xin;ZHANG Zhigang;ZHANG Caiyun;TIAN Jinhui(Department of Intensive Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu Province,China;Department of Nursing,the First Hospital of Lanzhou University;Evidence Based Medicine Center,Lanzhou University,Gansu Province,China)

机构地区：[1]兰州大学第一医院重症医学科,兰州730000 [2]兰州大学第一医院护理部 [3]兰州大学循证医学中心,兰州730000

出　　处：《解放军护理杂志》2018年第20期36-41,73,共7页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨俯卧位通气对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者临床不良事件的影响。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普、万方等数据库中关于俯卧位通气对ARDS患者影响的临床随机对照试验,并进行文献质量评价和资料分析。结果共纳入8篇文献,纳入患者2141例。Meta分析显示:俯卧位通气组在压疮、人工气道阻塞风险发生率方面高于对照组,差异有统计学意义(均P<0.05);两组在非计划拔管、呼吸机相关性肺炎、气胸风险发生率方面并无差异(均P>0.05);而俯卧位通气组在心律失常风险发生率方面低于对照组,差异有统计学意义(P<0.05)。结论俯卧位通气可增加ARDS患者压疮、人工气道阻塞风险发生,但并不增加非计划性拔管风险的发生;俯卧位通气可降低ARDS患者心率失常风险发生,但并不降低呼吸机相关性肺炎、气胸风险的发生率。本文可为ARDS患者行俯卧位通气治疗提供循证护理依据。Objective To evaluate the clinical adverse events of prone position in ventilated patients with acute respiratory distress syndrome(ARDS).Methods The PubMed,Web of Science,Embase,Cochrane Library,China National Knowledge Infrastructure,China Biology Medicine disc,VIP,Wanfang database were searched for the studies related to randomized controlled trials on the effect of prone position on ventilated patients with ARDS.Results Totally 8 studies were selected with 2141 patients.Meta-analysis showed that the incidences of pressure sore and artificial airway obstruction were higher in the prone-position ventilation group than those in the control group,the differences were statistically significant(all P<0.05);the unplanned extubation,ventilator-associated pneumonia and the incidence of pneumothorax in the two groups had no difference(all P>0.05).The incidence of arrhythmia was lower in the prone position ventilation group than that of the control group,the difference was statistically significant(P<0.05).Conclusions Prone position in ventilated patients can increase the risk of pressure ulcer and artificial airway obstruction in patients with ARDS,but it does not increase the risk of unplanned extubation.Prone ventilation can reduce the risk of arrhythmia in patients with ARDS,and there is no difference in the incidence of pneumonia and pneumothorax.This conclusion can provide evidence-based care for patients with ARDS who underwent prone-position ventilation.

关 键 词：俯卧位通气 急性呼吸窘迫综合征 META分析 

分 类 号：R473.56[医药卫生—护理学]