胸部超声对VAP诊断价值的Meta分析  

Meta-analysis of the diagnostic value of chest ultrasound in diagnosing ventilator-associated pneumonia

作　　者：张红华 李大欢 李洁[2] 张国秀[2] 魏晓蕾 Zhang Honghua;Li Dahuan;Li Jie;Zhang Guoxiu;Wei Xiaolei(Department of Emergency,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,China;Department of Emergency,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,Henan,China)

机构地区：[1]河南科技大学第二附属医院急诊科,河南洛阳471000 [2]河南科技大学第一附属医院急诊科,河南洛阳471003

出　　处：《中国中西医结合急救杂志》2021年第6期702-707,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河南省医学科技攻关指导性计划项目(201504010)。

摘　　要：目的评价胸部超声对诊断呼吸机相关性肺炎(VAP)的应用价值。方法通过计算机检索胸部超声诊断VAP的相关研究,检索语种限制为中文和英文。中文数据库为中国知网(CNKI)、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM),限制为核心期刊;英文数据库包括考克兰对照试验中心注册数据库(CENTRAL)、美国国立医学图书馆数据库(PubMed)、荷兰医学文摘(Embase),检索日期为自创刊到2020年9月1日。中文检索词为“超声”和“呼吸机相关性肺炎”,英语检索词为“Ultrasonography”or“Ultrasound”or“Sonography”and“Ventilator-associated pneumonia”or“VAP”。提取文献信息,通过诊断准确性研究的质量评价工具QUADAS-2对文献质量进行评价,使用Stata 15.0软件对原始数据进行合并分析。结果共有7个研究667名患者被纳入进行Meta分析,通过QUADAS-2量表对纳入研究进行质量评价,病例的选择为低风险偏移,部分研究没有提及盲法,可能存在一定风险偏移,纳入研究具有较好临床适用性。绘制Deeks漏斗图显示文献不存在发表偏倚(P>0.1)。诊断准确性的Meta分析显示,合并的敏感度、特异度、阳性似然比、阴性似然比以及诊断比值比(DOR)及其95%可信区间(95%CI)分别为0.75(95%CI 0.51~0.90)、0.78(95%CI 0.67~0.87)、3.50(95%CI 2.60~4.71)、0.31(95%CI 0.15~0.65)、11.18(95%CI 5.41~23.10);绘制合并受试者工作特征曲线(SROC),计算曲线下面积(AUC)为0.83(95%CI 0.80~0.86),提示超声对VAP具有较高的诊断效能。结论胸部超声对VAP诊断具有较高准确性,可以作为诊断VAP的重要检查工具。Objective To evaluate the value of chest ultrasound in the early diagnosis of ventilator-associated pneumonia(VAP).Methods The correlative study of chest ultrasound in diagnosis of VAP was searched by computer.The languages are limited to Chinese and English.The Chinese databases are CNKI,VIP,Wanfang Database and CBM,and they are limited to be core journals.The English database included The Cochrane Central Register of Controlled Trials(CENTRAL),PubMed,and Embase Databases.The retrieval date was from the inception to September 1,2020.The Chinese retrieval words were"Ultrasound"and"ventilator-associated pneumonia",the English retrieval words were"Ultrasonography"or"Ultrasound"or"Sonography"and"Ventilator-associated pneumonia"or"VAP".The literature information was extracted,the quality of the literature was evaluated by QUADAS-2,and the original data were combined and analyzed by stata 15.0 software.Results A total of 667 patients from 7 studies were enrolled in the Meta analysis.The quality of the included studies was evaluated by the QUADAS-2 scale.The selection of cases was a low-risk deviation.Some studies did not mention blinding.Deeks funnel chart showed that there was no publication bias(P>0.1).Overall pooled sensitivity and specificity for diagnosis of VAP by chest ultrasound were 0.75[95%confidence interval(95%CI)was 0.51-0.90]and 0.78(95%CI was 0.67-0.87)respectively.Overall pooled positive and negative predictive values were 3.50(95%CI was 2.60-4.71)and 0.31(95%CI was 0.15-0.65),pooled diagnostic odds ratio(DOR)was 11.18(95%CI was 5.41-23.10),and the area under synthetic receiver operator characteristic(SROC)curve(AUC)was 0.83(95%CI was 0.80-0.86).Conclusions Chest ultrasound is an accurate tool for the diagnosis of VAP,and can be used as an important diagnostic tool for VAP.

关 键 词：胸部超声 呼吸机相关性肺炎 重症监护病房 META分析 

分 类 号：R56[医药卫生—呼吸系统]