电阻抗断层显像导向呼气末正压滴定对急性呼吸窘迫综合征/急性呼吸衰竭患者影响的Meta分析  

Effect of electrical impedance tomography guided positive end-expiratory pressure titration on patients with acute respiratory distress syndrome/acute respiratory failure:a meta-analysis

作　　者：林晶[1] 陈佳龙 吴淡森[2] 李秀华 郭潇岚 石松菁[2] Lin Jing;Chen Jialong;Wu Dansen;Li Xiuhua;Guo Xiaolan;Shi Songjing(Shengli Clinical Medical College,Fujian Medical University,Fuzhou 350004,China;Department of Medical Intensive Care Unit,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350004 [2]福建省立医院重症医学二科,福州350001

出　　处：《中华危重症医学杂志（电子版）》2021年第3期226-231,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：福建省临床医学中心建设项目(2017-510)。

摘　　要：目的评价电阻抗断层显像技术(EIT)导向呼气末正压(PEEP)滴定对急性呼吸窘迫综合征/急性呼吸衰竭(ARDS/ARF)患者的影响。方法通过检索Pubmed、Embase、Web of science、Cochrane图书馆、中国知网、维普、万方中文数据库自建库至2020年3月10日关于EIT导向PEEP滴定对ARDS/ARF患者影响的相关研究。由2名研究员独立筛选文献、数据提取及质量评价后,使用RevMan 5.3软件进行Meta分析。结果共纳入7篇符合标准的临床研究,合计147例患者。Meta分析结果显示,相较于传统的PEEP设定方法(ARDS协作网、压力/容积曲线、流速/容积曲线),对ARDS/ARF患者使用EIT导向PEEP滴定后,PEEP值[均数差(MD)=2.35,95%置信区间(CI)(0.38,4.32),Z=2.34,P=0.02]及氧合指数[MD=26.63,95%CI(7.89,45.38),Z=2.78,P=0.005]均显著提高,肺顺应性[MD=5.06,95%CI(2.49,7.62),Z=3.86,P=0.000 1]显著改善。而EIT导向PEEP滴定与传统的PEEP设定方法对ARDS/ARF患者的平均动脉压[MD=-0.97,95%CI(-6.31,4.36),Z=0.36,P=0.72]及院内病死率[比值比=0.40,95%CI(0.14,1.12),Z=1.74,P=0.08]影响的比较,差异均无统计学意义。结论与传统的PEEP设定方法相比,EIT导向PEEP滴定可以提高ARDS/ARF患者的PEEP值及氧合指数,改善肺顺应性,但对患者平均动脉压及院内病死率无明显改善作用。Objective To systematically assess the effect of electrical impedance tomography(EIT)guided positive end-expiratory pressure(PEEP)titration on patients with acute respiratory distress syndrome(ARDS)/acute respiratory failure(ARF).Methods Systematic searches were performed in the PubMed,Embase,Web of science,Cochrane library,CNKI,VIP and Wanfang databases for articles published up to March 10,2020 about effects of EIT guided PEEP titration on ARDS/ARF patients.Two reviewers independently screened articles,extracted data and evaluated the quality of included studies.Then meta-analysis was conducted using RevMan5.3 software.Results Seven articles with 147 patients were enrolled in this study.Meta-analysis showed that compared with traditional PEEP setting methods(ARDS network,pressure/volume curve,flow rate/volume curve),the PEEP[mean difference(MD)=2.35,95%confidence interval(CI)(0.38,4.32),Z=2.34,P=0.02]and oxygenation index[MD=26.63,95%CI(7.89,45.38),Z=2.78,P=0.005]were higher,and the lung compliance[MD=5.06,95%CI(2.49,7.62),Z=3.86,P=0.0001]was better in ARDS/ARF patients with EIT guided PEEP titration.However,there was no significant difference in the mean arterial pressure[MD=-0.97,95%CI(-6.31,4.36),Z=0.36,P=0.72]and in-hospital mortality[odds ratio=0.40,95%CI(0.14,1.12),Z=1.74,P=0.08]between the EIT guided PEEP titration and traditional PEEP setting methods.Conclusion Compared with traditional PEEP setting methods,EIT guided PEEP titration can improve the PEEP,oxygenation index and lung compliance,but has no significant effect on the mean arterial pressure and in-hospital mortality of ARDS/ARF patients.

关 键 词：电阻抗断层显像 呼气末正压 呼吸窘迫综合征 成人 急性呼吸衰竭 META分析 

分 类 号：R563.8[医药卫生—呼吸系统]