中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
10期
587-591
,共5页
冷玉鑫%宋崖含%姚智渊%朱曦
冷玉鑫%宋崖含%姚智淵%硃晞
랭옥흠%송애함%요지연%주희
体位%45°半卧位%25°～30°卧位%机械通气%呼吸机相关性肺炎%荟萃分析
體位%45°半臥位%25°～30°臥位%機械通氣%呼吸機相關性肺炎%薈萃分析
체위%45°반와위%25°～30°와위%궤계통기%호흡궤상관성폐염%회췌분석
Body position%45°semirecumbent position%25°-30° position%Mechanical ventilation%Ventilator associated pneumonia%Meta analysis
目的 系统分析45°半卧位对机械通气患者呼吸机相关性肺炎(VAP)发生率和其他结局的影响,并综合评价45°半卧位是否较25°～ 30°具有优势.方法 检索1990年1月1日至2012年7月20日Cochrane临床试验数据库、美国《医学索引》(MEDLINE)、生物医学与药物学文摘数据库(Embase)、中国期刊全文数据库(CNKI)、万方数据库中有关不同床头角度对机械通气患者结局影响的随机对照临床研究(RCT),应用RevMan 5.0软件进行荟萃分析(Meta分析).结果 最终纳入5个RCT研究,共427例患者.45°半卧位患者的VAP发生率显著低于非45°卧位患者[15.96％( 34/213)比26.64％ (57/214),相对危险度(RR) =0.57,95％可信区间(95％ CI)为(0.39,0.83),P=0.003]；而不同体位对患者VAP病死率[27.04％ (53/196)比28.22％(57/202),RR=0.93,95％CI (0.68,1.27),P=0.66]、住重症监护病房(ICU)时间[加权均数差(WMD)=-0.45,95％CI(-1.08,0.18),P=0.16]、抗菌药物应用率[71.11％(32/45)比60.87％(28/46),RR=1.14,95％ CI(0.85,1.53),P=0.37]无显著影响.对5项研究中的2项(91例)进行了45°(45例)和25°～30°(46例)的亚组分析,结果显示,45°半卧位对MV患者的临床结局较25°～30°卧位并无显著优势.结论 45°半卧位对降低机械通气患者VAP发生率确实有效,但其是否优于25°～30°卧位仍须大样本的RCT研究来证实.
目的 繫統分析45°半臥位對機械通氣患者呼吸機相關性肺炎(VAP)髮生率和其他結跼的影響,併綜閤評價45°半臥位是否較25°～ 30°具有優勢.方法 檢索1990年1月1日至2012年7月20日Cochrane臨床試驗數據庫、美國《醫學索引》(MEDLINE)、生物醫學與藥物學文摘數據庫(Embase)、中國期刊全文數據庫(CNKI)、萬方數據庫中有關不同床頭角度對機械通氣患者結跼影響的隨機對照臨床研究(RCT),應用RevMan 5.0軟件進行薈萃分析(Meta分析).結果 最終納入5箇RCT研究,共427例患者.45°半臥位患者的VAP髮生率顯著低于非45°臥位患者[15.96％( 34/213)比26.64％ (57/214),相對危險度(RR) =0.57,95％可信區間(95％ CI)為(0.39,0.83),P=0.003]；而不同體位對患者VAP病死率[27.04％ (53/196)比28.22％(57/202),RR=0.93,95％CI (0.68,1.27),P=0.66]、住重癥鑑護病房(ICU)時間[加權均數差(WMD)=-0.45,95％CI(-1.08,0.18),P=0.16]、抗菌藥物應用率[71.11％(32/45)比60.87％(28/46),RR=1.14,95％ CI(0.85,1.53),P=0.37]無顯著影響.對5項研究中的2項(91例)進行瞭45°(45例)和25°～30°(46例)的亞組分析,結果顯示,45°半臥位對MV患者的臨床結跼較25°～30°臥位併無顯著優勢.結論 45°半臥位對降低機械通氣患者VAP髮生率確實有效,但其是否優于25°～30°臥位仍鬚大樣本的RCT研究來證實.
목적 계통분석45°반와위대궤계통기환자호흡궤상관성폐염(VAP)발생솔화기타결국적영향,병종합평개45°반와위시부교25°～ 30°구유우세.방법 검색1990년1월1일지2012년7월20일Cochrane림상시험수거고、미국《의학색인》(MEDLINE)、생물의학여약물학문적수거고(Embase)、중국기간전문수거고(CNKI)、만방수거고중유관불동상두각도대궤계통기환자결국영향적수궤대조림상연구(RCT),응용RevMan 5.0연건진행회췌분석(Meta분석).결과 최종납입5개RCT연구,공427례환자.45°반와위환자적VAP발생솔현저저우비45°와위환자[15.96％( 34/213)비26.64％ (57/214),상대위험도(RR) =0.57,95％가신구간(95％ CI)위(0.39,0.83),P=0.003]；이불동체위대환자VAP병사솔[27.04％ (53/196)비28.22％(57/202),RR=0.93,95％CI (0.68,1.27),P=0.66]、주중증감호병방(ICU)시간[가권균수차(WMD)=-0.45,95％CI(-1.08,0.18),P=0.16]、항균약물응용솔[71.11％(32/45)비60.87％(28/46),RR=1.14,95％ CI(0.85,1.53),P=0.37]무현저영향.대5항연구중적2항(91례)진행료45°(45례)화25°～30°(46례)적아조분석,결과현시,45°반와위대MV환자적림상결국교25°～30°와위병무현저우세.결론 45°반와위대강저궤계통기환자VAP발생솔학실유효,단기시부우우25°～30°와위잉수대양본적RCT연구래증실.
Objective To systemically analyze the effect of 45° semirecumbent position on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients,and to evaluate whether 45° semirecumbent position is superior to 25°-30° head of bed (HOB).Methods The randomized controlled trials (RCTs) comparing the effect of different HOB on the outcomes of mechanical ventilated patients were searched (from 1st January 1990 to 20th July 2012) from five databases including the Cochrane Central Register of Controlled Trials,MEDLINE,Embase,China Knowledge Resource Integrated Database (CNKI),and Wanfang Database.Meta analysis was conducted using RevMan 5.0 software.Results Data extracted from five RCTs with a total of 427 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients in semirecumbent 45° position compared to the patients in lower position [ 15.96％ (34/213 ) vs.26.64％ (57/214),relative risk (RR)=0.57,95％ confidence interval (95％ CI) 0.39 to 0.83,P=0.003],while no significant differences were detected between the two groups regarding the mortality rate [ 27.04％ ( 53/196 ) vs.28.22％ (57/202),RR =0.93,95％ CI 0.68to 1.27,P=0.66],the length of intensive care unit (ICU) stay [weighted mean difference (WMD)=-0.45,95％ CI-1.08 to 0.18,P=0.16]and the percentage of antibiotics treatment [71.11％ (32/45) vs.60.87％ (28/46),RR=1.14,95％CI 0.85 to 1.53,P=0.37].Two of the five trials (91 patients) were included in the sub-analysis between 45° group (45 patients ) and 25 ° -30° group (46 patients).The results showed that comparing with 25 ° -30°,45°semirecumhent position had no significance in improving patients' clinical outcomes.Conclusion This study proved that the clinically preferred semirecumbent 45° position did have effect in reducing the incidence of VAP,nevertheless,whether it's superior to 25° -30° needs to be confirmed by larger-scale,higher-quality RCTs.
