CAJ | 학술논문

目的观察加强手卫生对呼吸机相关性肺炎(VAP)发病率的影响.方法计算机检索和手工检索中、英文数据库1992年7月至2013年6月发表的加强手卫生对VAP发病率影响的临床研究,按纳入与排除标准选择文献,提取资料,采用RevMan 5.0软件对数据进行荟萃分析(Meta分析).结果共纳入6篇文献,均为前后对照研究,加强手卫生前后机械通气日分别为28 461和32 428,VAP发病率分别为39.5/1 000个机械通气日和19.5/1 000个机械通气日.加强手卫生的具体措施包括提供便捷的手卫生清洁装置,长期的教育、监督与反馈,以及积极提高手卫生的依从性.6篇文献均显示加强手卫生可降低VAP发病率,降低程度29.8％～65.5％,平均50.6％.Meta分析显示,加强手卫生对VAP有明显的保护作用[优势比(OR)1.43 ～ 5.82,合并OR为2.23,95％可信区间(95％CI)为1.62 ～ 3.07,P＜ 0.000 01].漏斗图显示,文章发表偏倚不大.结论加强手卫生对VAP具有保护作用,可以降低VAP的发病率,然而研究文献的低质量限制了结论的可信度.
목적 관찰가강수위생대호흡궤상관성폐염(VAP)발병솔적영향.방법 계산궤검색화수공검색중、영문수거고1992년7월지2013년6월발표적가강수위생대VAP발병솔영향적림상연구,안납입여배제표준선택문헌,제취자료,채용RevMan 5.0연건대수거진행회췌분석(Meta분석).결과 공납입6편문헌,균위전후대조연구,가강수위생전후궤계통기일분별위28 461화32 428,VAP발병솔분별위39.5/1 000개궤계통기일화19.5/1 000개궤계통기일.가강수위생적구체조시포괄제공편첩적수위생청길장치,장기적교육、감독여반궤,이급적겁제고수위생적의종성.6편문헌균현시가강수위생가강저VAP발병솔,강저정도29.8％～65.5％,평균50.6％.Meta분석현시,가강수위생대VAP유명현적보호작용[우세비(OR)1.43 ～ 5.82,합병OR위2.23,95％가신구간(95％CI)위1.62 ～ 3.07,P＜ 0.000 01].루두도현시,문장발표편의불대.결론 가강수위생대VAP구유보호작용,가이강저VAP적발병솔,연이연구문헌적저질량한제료결론적가신도.
Objective To determine the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia (VAP).Methods Clinical studies which were related to enhanced hand cleansing to the risk of VAP,which were published between July 1992 and June 2013 in English or Chinese were retrieved via computer and manual screening.Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with RevMan 5.0 software.Results A total of 6 studies,all of which were performed with well controlled protocol,involving 28 461 mechanical ventilator days and 32 428 mechanical ventilator days were analyzed.The morbidity of VAP was 39.5 days per 1 000 mechanical ventilator days and 19.5 days per 1 000 mechanical ventilator days before and after enhanced hand cleaning,respectively.The methods of enhancing hand hygiene included feasible hand hygiene apparatus,long-term education,supervision and feedback,as well as increased hand cleaning compliance.All 6 eligible studies reported that enhanced hand washing lowered the risk of VAP,with risk reduction ranging from 29.8％ to 65.5％ with a mean reduction value of 50.6％.Meta analysis showed that enhanced hand cleaning could protect patients from VAP with odds ratio (OR) varying from 1.43 to 5.82 [pooled OR=2.23,95％ confidence interval (95％CI) 1.62-3.07,P＜0.000 01].It was showed in funnel chart that bias in the published articles was not significant.Conclusions Enhanced hand hygiene has an effect of prevention of VAP morbidity and is associated with lowered morbidity of VAP.However,the reliability of this conclusion is questionable because of poor quality of these studies.