CAJ | 학술논문

目的评价气管切开时机对长期机械通气患者预后的影响.方法通过计算机检索Pubmed、Embase、The Cochrane Library数据库和中国生物医学文献数据库(CBM)并联合手工检索,收集1990年1月至2010年6月关于气管切开时机对长期机械通气患者预后影响的随机对照研究(RCT),并对收集的RCT进行评价,按Cochrane协作网推荐的方法对早期气管切开和晚期气管切开对长期机械通气患者预后的影响作meta分析,采用Review Manager(RevMan)5.0软件进行统计学分析.将早期气管切开组定义为入院或入住ICU后气管插管或机械通气后＜10 d;晚期气管切开组定义为入院或入住ICU后气管插管或机械通气后＞10 d(包括继续气管插管机械通气者或者气管切开者).结果经过筛查最终共纳入6项RCT,总病例数828例,其中早期气管切开组411例,晚期气管切开组417例.经过统计分析显示,与晚期气管切开组相比,早期气管切开可降低长期机械通气患者的病死率(RR:0.81,95%CI:0.66～0.99,P=0.04),但不降低长期机械通气患者的肺炎发生率(RR:0.89,95%CI:0.68～1.17,P=0.41),机械通气时间(平均差为-2.19,95%CI:-9.86～5.49,P=0.58)和ICU住院时间(平均差为-5.65,95%CI:-17.11～5.81,P=0.33).结论早期气管切开可能降低长期机械通气患者的病死率,对长期机械通气患者的肺炎发生率、机械通气时间和ICU住院时间无改善,但仍需要进一步证实.
목적 평개기관절개시궤대장기궤계통기환자예후적영향.방법 통과계산궤검색Pubmed、Embase、The Cochrane Library수거고화중국생물의학문헌수거고(CBM)병연합수공검색,수집1990년1월지2010년6월관우기관절개시궤대장기궤계통기환자예후영향적수궤대조연구(RCT),병대수집적RCT진행평개,안Cochrane협작망추천적방법대조기기관절개화만기기관절개대장기궤계통기환자예후적영향작meta분석,채용Review Manager(RevMan)5.0연건진행통계학분석.장조기기관절개조정의위입원혹입주ICU후기관삽관혹궤계통기후＜10 d;만기기관절개조정의위입원혹입주ICU후기관삽관혹궤계통기후＞10 d(포괄계속기관삽관궤계통기자혹자기관절개자).결과 경과사사최종공납입6항RCT,총병례수828례,기중조기기관절개조411례,만기기관절개조417례.경과통계분석현시,여만기기관절개조상비,조기기관절개가강저장기궤계통기환자적병사솔(RR:0.81,95%CI:0.66～0.99,P=0.04),단불강저장기궤계통기환자적폐염발생솔(RR:0.89,95%CI:0.68～1.17,P=0.41),궤계통기시간(평균차위-2.19,95%CI:-9.86～5.49,P=0.58)화ICU주원시간(평균차위-5.65,95%CI:-17.11～5.81,P=0.33).결론 조기기관절개가능강저장기궤계통기환자적병사솔,대장기궤계통기환자적폐염발생솔、궤계통기시간화ICU주원시간무개선,단잉수요진일보증실.
Objective To evaluate the effect of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients. Methods Randomized controlled trials (RCTs) that studied the effect of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients were searched from Pubmed, Embase, The Cochrane Library, CBM during January 1990 to June 2010. The quality of the RCTs was evaluated. Meta-analysis of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients were conducted using the methods recommended by the Cochrane Collaboration. Definition of early tracheotomy was the patients performed tracheotomy during 10 days after admission to hospital or ICU,mechanical ventilation or intubation. Late tracheotomy was defined tracheotomy performed beyond 10 days of admission to hospital or ICU, mechanical ventilation or intubation; or those mechanically ventilated through intubation all the time. Results Eight hundred and twenty eight patients, 411 in early tracheotomy group and 417 in late tracheotomy group, from 6 RCTs were included in the analysis of data. The meta-analysis showed that early tracheotomy could reduce mortality of patients ( RR:0. 81,95% CI:0. 66-0.99 ,P=0.04);but it didn't significantly alter the incidence of pneumonia (RR: 0. 89,95% CI:0.68-1.17, P=0.41),mechanical ventilation days (mean difference: -2. 19,95% CI: -9. 86-5.49,P =0. 58) and length of ICU stay (mean difference:-5.65,95%CI:-17.11-5.81,P =0.33).Conclusions In critically ill adult patients who require prolonged mechanical ventilation, early tracheotomy performed at an earlier stage reduces the mortality, but doesn't reduce the incidence of pneumonia and shorten the mechanical ventilation days and ICU length of stay. But more high quality RCTs are required to confirm it.