俯卧位通气治疗急性呼吸窘迫综合征患者疗效的Meta分析  

Effect of prone positioning on acute respiratory distress syndrome: a systematic review and meta-analysis

作　　者：李长城 余旻[1] LI Chang-cheng;YU Min(Department of Intensive Care Unit,Renmin Hospital of Three Gorges University,the First People’s Hospital of Yichang,Yichang 443700,Hubei,CHINA)

机构地区：[1]三峡大学人民医院宜昌市第一人民医院

出　　处：《海南医学》2020年第4期529-533,共5页Hainan Medical Journal

基　　金：湖北省宜昌市卫生科技项目基金(编号：A19-301-16)

摘　　要：目的评估俯卧位通气对急性呼吸窘迫综合征(ARDS)患者预后的影响。方法通过计算机及手工检索收集1966年1月至2019年6月俯卧位通气治疗ARDS的中英文随机临床对照试验(RCT),检索范围包括PubMed、Embase、Cochrane图书馆以及中国学术期刊全文数据库(CNKI),然后对照纳入及排除标准收集文献并提取数据,采取Review Manager 5.3软件进行Meta分析。结果共纳入5篇RCT研究,其中4项RCT研究了俯卧位通气对ARDS患者病死率的影响,与对照组相比,俯卧位通气可降低ARDS患者的病死率(OR=2.72,95%CI 1.94~3.82),其中2项RCT研究了俯卧位通气对ARDS患者机械通气时间的影响,与对照组相比,俯卧位通气可缩短ARDS患者的机械通气时间(MD=5.84,95%CI 3.56~8.13),其中3项RCT研究了俯卧位通气对ARDS患者ICU住院时间的影响,与对照组相比,俯卧位通气并不能缩短ICU住院时间(MD=0.24,95%CI-4.14~4.63),其中3项RCT研究了俯卧位通气对ARDS患者发生呼吸机相关性肺炎(VAP)的影响,俯卧位通气VAP发生率低于对照组(OR=0.67,95%CI 0.45~1.00)。结论俯卧位通气能够降低ARDS患者的病死率、机械通气时间以及VAP发生率,但不能降低ICU住院时间。Objective To explore the effect of prone positioning on acute respiratory distress syndrome.Methods Literature concerning randomized controlled trials(RCTs) from January 1966 to June 2019 on prone positioning for the treatment of ARDS patients was collected by computer and manual retrieval. The scope of the search included PubMed, Embase, Cochrane, CNKI. Meta-analysis of the use of prone positioning in the treatment of ARDS patients was conducted using the Review Manager 5.3 software. Results A total of 5 RCT studies were included. Four RCTs studied the effect of prone positioning on mortality in patients with ARDS: compared with the control group, prone positioning reduced mortality in ARDS patients(OR=2.72, 95%CI 1.94-3.82). Two RCTs studied the effect of prone positioning on mechanical ventilation time in patients with ARDS: compared with the control group, prone positioning shortened the mechanical ventilation time of patients with ARDS(MD=5.84, 95% CI 3.56-8.13). Three RCTs studied the effect of prone positioning on the length of ICU stay in patients with ARDS: as compared with the control group,prone positioning did not shorten the length of ICU stay(MD=0.24, 95% CI-4.14 to 4.63). Three RCTs studied the effect of prone positioning on ventilator-associated pneumonia(VAP) in patients with ARDS: compared with the control group, the incidence of VAP in prone positioning was lower than that of the control group(OR=0.67, 95% CI 0.45-1.00). Conclusion Prone positioning can reduce the mortality, mechanical ventilation time, and VAP incidence of ARDS patients, but cannot reduce ICU hospitalization time.

关 键 词：俯卧位 急性呼吸窘迫综合征 病死率 机械通气时间 ICU住院时间 呼吸机相关性肺炎 

分 类 号：R56[医药卫生—呼吸系统]