重型颅脑损伤患者应用密闭式或开放式吸痰效果比较的meta分析  

Comparison of the effect between closed endotracheal suctioning and open endotracheal suctioning on patients with severe craniocerebral injury: a meta-analysis

作　　者：王玢 丁星星 孙瑶环 王慧 董银凤[1] WANG Bin;DING Xingxing;SUN Yaohuan;WANG Hui;DONG Yinfeng(School of Nursing Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210023,China)

机构地区：[1]南京中医药大学护理学院,江苏南京210023

出　　处：《中华全科医学》2023年第3期509-513,共5页Chinese Journal of General Practice

基　　金：江苏省自然科学基金面上项目(BK20201402)。

摘　　要：目的 系统评价密闭式和开放式吸痰在行机械通气的重度颅脑损伤患者中的应用效果,旨在为其吸痰方式的合理选择提供依据。方法 计算机检索PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网、万方、维普及中国生物医学文献数据库,筛选关于密闭式和开放式吸痰对重型颅脑损伤患者干预效果比较的随机对照试验,由2名研究者按照纳排标准独立筛选文献,并进行质量评价和资料提取。最后采用RevMan5.3软件进行meta分析。结果 共纳入7项研究,包括462例研究对象。Meta分析结果显示,密闭式吸痰与开放式吸痰相比,可降低吸痰时颅内压(MD=-3.46,95%CI:-4.85~-2.08,P<0.001)和吸痰后5 min的颅内压(MD=-3.33,95%CI:-3.92~-2.74,P<0.001),并增加血氧饱和度(MD=3.95,95%CI:3.28~4.62,P<0.001)、提高动脉血氧分压(MD=19.06,95%CI:12.97~25.15,P<0.001)及降低呼吸机相关性肺炎的发生率(RR=0.21,95%CI:0.10~0.43,P<0.001);而2种吸痰方式对吸痰后15 min的颅内压、吸痰时和吸痰后脑灌注压的影响差异无统计学意义。结论 密闭式吸痰比开放式吸痰更有利于稳定重型颅脑损伤患者的颅内压、血氧饱和度和动脉血氧分压,并降低呼吸机相关性肺炎的发生率。Objective To systematically evaluate the effects of closed and open endotracheal suctioning on patients with severe craniocerebral injury and provide scientific evidence for their selection.Methods We searched databases,including PubMed,Web of Science,EMBASE,the Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,VIP database and China Biology Medicine Disc(CBM),for randomised controlled trials of closed and open endotracheal suctioning on patients with severe craniocerebral injury.Studies were independent selected by two researchers in accordance with the inclusion and exclusion criteria.Then,data were extracted,and the quality of literature was evaluated.Finally,RevMan 5.3 software was used to meta-analysis.Results Seven randomised controlled trials including 462 patients were included.The results of meta-analysis showed that the closed endotracheal suctioning was significantly superior to open endotracheal suctioning in decreasing intracranial pressure during suctioning(MD=-3.46,95% CI:-4.85 to-2.08,P<0.001) and at 5 min after suctioning(MD=-3.33,95% CI:-3.92 to-2.74,P<0.001),increasing SpO2(MD=3.95,95% CI: 3.28-4.62,P<0.001) and PaO2(MD=19.06,95% CI: 12.97-25.15,P<0.001),and reducing the incidence of ventilator-associated pneumonia(RR=0.21,95% CI: 0.10-0.43,P<0.001).However,no significant influence on intracranial pressure was observed at 15 min after suctioning and on cerebral operfusion pressure during or after suctioning.Conclusion Compared with open endotracheal suctioning,closed endotracheal suctioning is more conductive to stabilising intracranial pressure,SpO2and PaO2and reducing the incidence of ventilator-associated pneumonia in patients with severe craniocerebral injury.

关 键 词：重型颅脑损伤 密闭式吸痰 开放式吸痰 META分析 

分 类 号：R651.15[医药卫生—外科学]