不同吸痰方式对机械通气患者临床效果的meta分析  

Meta-analysis of the clinical effect of different sputum suction methods on mechanically ventilated patients

作　　者：王晶 胡涛 金凤 黄玉民 邱瑾 欧阳晓平 WANG Jing;HU Tao;JIN Feng;HUANG Yumin;QIU Jin;OU YANG Xiaoping(Department of Infectious Diseases,Affiliated Hospital of Yangzhou University,Jiangsu Province,Yangzhou225000,China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Yangzhou University,Jiangsu Province,Yangzhou225000,China)

机构地区：[1]扬州大学附属医院感染性疾病科,江苏扬州225000 [2]扬州大学附属医院呼吸与危重医学科,江苏扬州225000

出　　处：《中国医药导报》2022年第28期96-101,共6页China Medical Herald

基　　金：国家自然科学基金资助项目(81903850)。

摘　　要：目的评价不同吸痰方式对预防呼吸机相关性肺炎(VAP)的临床效果。方法对The Cochrane Library、万方数据库、PubMed、维普和中国期刊全文数据库进行检索,收集机械通气患者使用开放式吸痰(OTSS)和密闭式吸痰(CTSS)对预防VAP的效果比较的随机对照试验(RCTs),检索时限从建库至2021年5月。两名研究人员对文献进行质评和资料提取,利用RevMan 5.3统计处理,对纳入的RCTs进行meta分析。结果共15篇RCTs,共3029例患者。meta分析结果显示,CTSS可降低VAP发生率[OR=0.74,95%CI(0.59~0.93),P=0.01]及患者心律失常发生率[OR=0.23,95%CI(0.07~0.74),P=0.01]。在缩短ICU住院日[MD=-0.13,95%CI(-2.23~1.96),P=0.9]、降低呼吸道微生物定植率[OR=1.14,95%CI(0.90~1.45),P=0.29]、机械通气时间[MD=-1.46,95%CI(-3.13~0.20),P=0.08]和住院病死率[OR=1.01,95%CI(0.84~1.23),P=0.89]方面,两者比较差异无统计学意义。结论CTSS在预防机械通气患者VAP的发生及减少心律失常方面较OTSS存在优势,在缩短ICU住院时间、降低病死率、缩短机械通气时间及降低呼吸道微生物定植率方面并不存在优势。Objective To evaluate the clinical effect of different sputum suction methods on the prevention of ventilator-associated pneumonia(VAP).Methods The Cochrane Library,Wanfang Data,PubMed,VIP,and Chinese journal full-text databases were searched to collect randomized controlled trials(RCTs)comparisons of the effects of open sputum suction(OTSS)and closed sputum suction(CTSS)on VAP in mechanically ventilated patients trial,the search period was from the establishment of the database to May 2021.Two researchers conducted quality evaluation and data extraction of the literature,and used RevMan 5.3 statistical processing to conduct a meta-analysis of the included RCTs.Results A total of 15 RCTs with a total of 3029 patients were included.Meta-analysis results showed that CTSS could reduce the incidence of VAP(OR=0.74,95%CI[0.59 to 0.93],P=0.01)and the incidence of arrhythmia(OR=0.23,95%CI[0.07 to 0.74],P=0.01),there was no statistically significant difference between the two in terms of shortened ICU stay(MD=-0.13,95%CI[-2.23 to 1.96],P=0.9),decreased respiratory tract microbial colonization rate(OR=1.14,95%CI[0.84 to 1.23],P=0.89).Conclusion CTSS has advantages over OTSS in preventing the occurrence of VAP and reducing arrhythmia in mechanically ventilated patients,but not in shortening ICU hospital stay,reducing mortality,shortening mechanical ventilation time and reducing respiratory tract microbial colonization rate.

关 键 词：机械通气 密闭式吸痰系统 开放式吸痰系统 呼吸机相关性肺炎 随机对照试验 

分 类 号：R472[医药卫生—护理学]