驱动压指导PEEP滴定用于术中机械通气的meta分析  

Driving pressure-guided PEEP titration for intraoperativemechanical ventilation:a meta-analysis

作　　者：周建雄 刘春雨 魏闯 ZHOU Jianxiong;LIU Chunyu;WEI Chuang(Department of Anesthesiology,Chongqing University Cancer Hospital,Chongqing 400030,China)

机构地区：[1]重庆大学附属肿瘤医院麻醉科,重庆400030

出　　处：《重庆医学》2024年第5期760-765,共6页Chongqing medicine

基　　金：中央引导地方科技发展专项[渝财规(2016)5号]。

摘　　要：目的 系统评价驱动压指导固定呼气末正压(PEEP)滴定用于术中机械通气的有效性与安全性。方法 计算机检索PubMed、Web of Science、the Cochrane Library、Embase、中国知网(CNKI)、万方和维普数据库,检索驱动压指导PEEP滴定用于术中机械通气的随机对照研究(RCT),检索时间为建库至2023年11月8日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行meta分析。结果 共纳入19篇文献,共计患者2 906例,研究组采用驱动压指导PEEP滴定的肺保护通气策略,共计患者1 440例,对照组采用传统肺保护通气策略,共计患者1 466例。与对照组比较,研究组在非胸科手术中术后肺部并发症(PPCs)发生率更低(RR=0.53,95%CI:0.43~0.65,P<0.001),而在胸科手术中差异无统计学意义(RR=0.89,95%CI:0.78~1.02,P=0.09)。与对照组比较,研究组术中肺顺应性升高(MD=6.90 L/cmH_(2)O,95%CI:5.80~7.99,P<0.001),住院时间缩短(MD=-0.27 d, 95%CI:-0.43~-0.12,P<0.001),而术中平均动脉压(MAP)差异无统计学意义(MD=0.36 mmHg, 95%CI:-1.30~2.01,P=0.67)。结论 与传统肺保护通气比较,驱动压指导PEEP滴定通气能够提高患者术中肺顺应性,降低非胸科手术PPCs发生率,缩短住院时间,且不增加血流动力学紊乱的风险。Objective To systematic evaluate the effectiveness and safety of driving pressure-guided fixed positive end-expiratory pressure(PEEP)titration in intraoperative mechanical ventilation.Methods PubMed,Web of Science,the Cochrane Library,Embase,CNKI,Wanfang and VIP databases were searched for collect randomized controlled trials(RCTs)of PEEP titration guided by driving pressure in intraoperative mechanical ventilation from inception to November 8,2023.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias of the included studies,the meta-analysis was conducted by RevMan 5.4 software.Results Nineteen studies with a total of 2906 patients were included.There were 1440 patients in the study group with the lung protective ventilation strategy guided by PEEP titration,and 1466 patients in the control group with the traditional lung protective ventilation strategy.Compared with the control group,the incidence of postoperative pulmonary complications(PPCs)in the study group was lower in the non-thoracic surgery(RR=0.53,95%CI:0.43-0.65,P<0.001),but there was no statistical difference in the incidence of PPCS in the thoracic surgery(RR=0.89,95%CI:0.78-1.02,P=0.09).Compared with the control group,the intraoperative lung compliance was increased(MD=6.90 L/cmH 2O,95%CI:5.80-7.99,P<0.001),and the length of hospital stay was shortened in the study group(MD=-0.27 d,95%CI:-0.43 to-0.12,P<0.001),while there was no significant difference in intraoperative mean arterial pressure(MAP)bet ween the two groups(MD=0.36 mmHg,95%CI:-1.30 to 2.01,P=0.67).Conclusion Compared with the traditional lung protective ventilatio n,driving pressure-guided PEEP titration ventilation can improve intraoperative lung compliance,reduce the incidence of PPCs in non-thoracic surgery,shorten the length of hospital stay,and does not increase the risk of hemodynamic disturbances in patients undergoing surgery.

关 键 词：驱动压 肺保护性通气 术后肺部并发症 META分析 

分 类 号：R614[医药卫生—麻醉学]