气流冲击法对人工气道患者呼吸机相关性肺炎预防效果的系统评价  

A systematic review of the effect of rapid flow expulsion maneuver on the prevention of ventilator associated pneumonia in patients with artificial airway

作　　者：邓伟 王英[1] 李小珍[1] 黄慧[1] 田凤美[1] Deng Wei;Wang Ying;Li Xiaozhen;Huang Hui;Tian Fengmei(The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院,215004

出　　处：《国际护理学杂志》2022年第18期3349-3357,共9页international journal of nursing

基　　金：2021年度苏州市护理学会姑苏护理人才"青苗"计划(SHQM202104)。

摘　　要：目的评价气流冲击法对人工气道患者气囊上分泌物清除效果及呼吸机相关性肺炎的预防效果。方法计算机检索英文数据库The Cochrane Library、MEDLINE(PubMed)、Web of Science、Embase和Ovid,中文数据库中国知网(CNKI)、万方医学网、维普数据库。检索时间范围为建库始至2021年8月26日。纳入的研究类型为临床随机对照试验。采用澳大利亚JBI循证卫生保健中心(2016)对随机对照试验论文的质量评价工具,RevMan 5.3.0软件进行Meta分析。结果共纳入9篇文献,共836例患者。本研究结果显示,两组患者呼吸机相关性肺炎发生率、24 h气囊上滞留物吸引量、ICU住院时长、机械通气时长、气道黏膜损伤情况比较差异有统计学意义(P<0.05)。结论与声门下吸引相比,气流冲击法可降低VAP发生率、增加24 h气囊上滞留物引出量,降低气道黏膜损伤的发生率,减少机械通气时长,缩短ICU住院时长。但存在部分结局指标缺乏符合纳入标准的原始研究,同时部分研究异质性较大,文献质量偏低的缺点。Objective To evaluate the effects of the rapid flow expulsion maneuver and subglottic suction for the prevention of ventilator-associated pneumonia.Methods The English databases The Cochrane Library,MEDLINE(PubMed),Web of Science,Embase and Ovid,and The Chinese databases CNKI,Wanfang Medical Network and VIP were searched by computer.The search time range was from the establishment of the database to August 26,2021.The type of study included was a clinical randomized controlled trial.RevMan 5.3.0,a quality assessment tool for randomized controlled trial papers,was used for meta-analysis by Australian JBI Evidence-based Health Care Center(2016).Results A total of 9 articles with 836 patients were included.The results of this study showed that there were statistically significant differences between the two groups in the incidence of ventilator-associated pneumonia,retention volume on the airbag in 24 hours,length of ICU stay,length of mechanical ventilation and airway mucosal injury(P<0.05).Conclusions Compared with subglottic suction,the rapid flow expulsion maneuver can reduce the incidence of VAP,increase daily volume of subglottic secretions cleared in 24 hours,reduce the incidence of airway mucosal injury,reduce the duration of mechanical ventilation and shorten the length of ICU stay.However,there are shortcomings such as lack of original studies that meet the inclusion criteria for some outcome indicators,large heterogeneity of some studies,and low literature quality.

关 键 词：声门下吸引 气流冲击法 呼吸机相关性肺炎 系统评价 

分 类 号：R563.1[医药卫生—呼吸系统]