不同体位对成人ARDS行机械通气患者影响的网状Meta分析  

Influence of different positions on adult patients with ARDS undergoing mechanical ventilation:a network Meta-analysis

作　　者：陈洁如 王梦琪 陈泓伯 施月仙 尚少梅[1] Chen Jieru;Wang Mengqi;Chen Hongbo;Shi Yuexian;Shang Shaomei(School of Nursing,Peking University,Beijing 100191,China)

机构地区：[1]北京大学护理学院,100191

出　　处：《中华现代护理杂志》2021年第31期4246-4255,共10页Chinese Journal of Modern Nursing

基　　金：国家重点研发计划重点项目(2020YFC2008800)。

摘　　要：目的采用网状Meta分析的方法从有效性和安全性2个方面评价不同体位干预方式对于ARDS行机械通气患者的效果。方法从PubMed、Embase、Cochrane Library、Web of Science、CINAHL、中国生物医学文献数据库、CNKI、维普、万方数据库中检索有关体位干预措施对于成人ARDS行机械通气患者治疗效果的RCT,检索时间为建库至2021年1月。按照文献纳入排除标准对文献进行筛选并进行质量评价、资料提取。采用StataSE 15统计软件和Addis1.16.6软件进行网状Meta分析。结果纳入31项RCT,涉及俯卧位、半卧位、侧卧位、平卧位和端坐位5种体位,共3738例患者。俯卧位与半卧位、半卧位与平卧位相比能降低患者28 d全因死亡率,差异有统计学意义(P<0.05);俯卧位与半卧位、平卧位相比能减少患者入住ICU时长,差异有统计学意义(P<0.05);俯卧位与平卧位相比能提高患者氧合指数,差异有统计学意义(P<0.05);对于不良事件及不良反应总发生率,任意2种体位对比差异无统计学意义(P>0.05);所有结局指标网状Meta概率排序显示,俯卧位和侧卧位较优,平卧位和半卧位优势不明显。结论当前证据表明,俯卧位和侧卧位干预措施对治疗ARDS行机械通气患者更为有效和安全,是几种体位中较优的选择。Objective To evaluate the effects of different position interventions in patients with acute respiratory distress syndrome(ARDS)undergoing mechanical ventilation from the aspects of effectiveness and safety using the method of network Meta-analysis.Methods Randomized clinical trials(RCTs)related to the therapeutic effect of position interventions in adult ARDS patients undergoing mechanical ventilation were retrieved in PubMed,Embase,Cochrane Library,Web of Science,CINAHL,China Biomedical Literature Database,China National Knowledge Infrastructure,VIP and WanFang Data.The search time limit was from the establishment of the database to January 2021.According to the literature inclusion and exclusion criteria,literature was screened and the quality evaluation and data extraction were carried out.StataSE 15 and Addis 1.16.6 were used for network Meta-analysis.Results A total of 31 RCTs were included,involving 5 positions of prone,semi-recumbent,side-recumbent,supine and sitting,and 3738 patients.The prone position compared with the semi-recumbent position,the semi-recumbent position compared with the supine position could reduce the 28-day all-cause mortality of the patient,and the difference was statistically significant(P<0.05).Compared with the semi-recumbent position and the supine position,the prone position could reduce the length of time the patient stayed in the ICU,and the difference was statistically significant(P<0.05).The prone position could increase the oxygenation index of patients compared with the supine position,and the difference was statistically significant(P<0.05).For the total incidence of adverse events and adverse reactions,there was no statistically significant difference between any two positions(P>0.05).The network Meta probability ranking of all the outcome indicators showed that the prone position and the side-recumbent position had advantages,and the supine position and the semi-recumbent position had no obvious advantages.Conclusions Current evidence shows that the prone and side-recu

关 键 词：呼吸窘迫综合征 成人 机械通气 网状Meta分析 体位 

分 类 号：R473.5[医药卫生—护理学]