浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
9期
780-784
,共5页
糖皮质激素%气管拔管%喉喘鸣%再插管
糖皮質激素%氣管拔管%喉喘鳴%再插管
당피질격소%기관발관%후천명%재삽관
Glucocorticoid%Tracheal extubation%Laryngeal stridor%Reintubation
目的：探讨糖皮质激素预防成人气管插管拔管后喉喘鸣和再插管发生率的作用。方法通过计算机和手工检索中文期刊数据库，Pubmed、Embase、Web of Science数据库，收集文献报道成人气管插管拔管前静脉注射地塞米松或氢化可的松或甲基强的松龙预防气管拔管后喉喘鸣和再插管发生率的临床随机双盲对照研究，并行Meta分析。结果纳入6篇随机双盲对照研究，患者共1717例，其中糖皮质激素预防组884例，0.9%氯化钠溶液安慰对照组833例。3篇文献应用气囊放气漏气量预测喉喘鸣高风险患者作为研究对象，3篇未进行喉喘鸣高风险患者筛选。拔管前静脉注射糖皮质激素能降低患者拔管后喉喘鸣发生率（RR 0.37，95%CI 0.21~0.64）；减少拔管后再插管发生率（RR 0.40,95%CI 0.25~0.63），但不能降低未进行喉喘鸣高风险评估亚组患者拔管后喉喘鸣发生率（RR 0.39，95%CI 0.13~1.21）。结论对成人喉喘鸣高风险患者建议在拔管前常规应用糖皮质激素预防拔管后喉喘鸣和再插管发生率，其作用与糖皮质激素预防使用的开始时间和使用剂量有关。
目的：探討糖皮質激素預防成人氣管插管拔管後喉喘鳴和再插管髮生率的作用。方法通過計算機和手工檢索中文期刊數據庫，Pubmed、Embase、Web of Science數據庫，收集文獻報道成人氣管插管拔管前靜脈註射地塞米鬆或氫化可的鬆或甲基彊的鬆龍預防氣管拔管後喉喘鳴和再插管髮生率的臨床隨機雙盲對照研究，併行Meta分析。結果納入6篇隨機雙盲對照研究，患者共1717例，其中糖皮質激素預防組884例，0.9%氯化鈉溶液安慰對照組833例。3篇文獻應用氣囊放氣漏氣量預測喉喘鳴高風險患者作為研究對象，3篇未進行喉喘鳴高風險患者篩選。拔管前靜脈註射糖皮質激素能降低患者拔管後喉喘鳴髮生率（RR 0.37，95%CI 0.21~0.64）；減少拔管後再插管髮生率（RR 0.40,95%CI 0.25~0.63），但不能降低未進行喉喘鳴高風險評估亞組患者拔管後喉喘鳴髮生率（RR 0.39，95%CI 0.13~1.21）。結論對成人喉喘鳴高風險患者建議在拔管前常規應用糖皮質激素預防拔管後喉喘鳴和再插管髮生率，其作用與糖皮質激素預防使用的開始時間和使用劑量有關。
목적：탐토당피질격소예방성인기관삽관발관후후천명화재삽관발생솔적작용。방법통과계산궤화수공검색중문기간수거고，Pubmed、Embase、Web of Science수거고，수집문헌보도성인기관삽관발관전정맥주사지새미송혹경화가적송혹갑기강적송룡예방기관발관후후천명화재삽관발생솔적림상수궤쌍맹대조연구，병행Meta분석。결과납입6편수궤쌍맹대조연구，환자공1717례，기중당피질격소예방조884례，0.9%록화납용액안위대조조833례。3편문헌응용기낭방기루기량예측후천명고풍험환자작위연구대상，3편미진행후천명고풍험환자사선。발관전정맥주사당피질격소능강저환자발관후후천명발생솔（RR 0.37，95%CI 0.21~0.64）；감소발관후재삽관발생솔（RR 0.40,95%CI 0.25~0.63），단불능강저미진행후천명고풍험평고아조환자발관후후천명발생솔（RR 0.39，95%CI 0.13~1.21）。결론대성인후천명고풍험환자건의재발관전상규응용당피질격소예방발관후후천명화재삽관발생솔，기작용여당피질격소예방사용적개시시간화사용제량유관。
Objective To evaluate the effects of glucocorticoids in prevention of post- extubative laryngeal stridor and reintubation in critical il adults. Methods Literatures in Chinese periodical database, Pubmed, Embase, Web of Science database from January1980 to June 2013 were searched. The randomized- double blind- placebo control ed clinical trials of post- extubative laryngeal stridor and reintubation after intravenous injection of dexamethasone, hydrocortisone, methylpred-nisolone in critical il adults were reviewed. The meta analysis was performed with the software recommended by Cochrane Col-laboration. Results A total of 884 glucocorticoid- pretreated cases and 833 saline placebo controls from six clinical trials were included. The high risk patients of laryngeal stridor were screened by cuff leak volume in 3 trials;while high risk patients were not screened in another 3 trials. Intravenous glucocorticoids reduced the incidence of post- extubative laryngeal stridor (RR=0.37, 95%CI 0.21~0.64) and incidence of reintubation(RR=0.40, 95%CI 0.25~0.63). In subgroups without high risk screening glucocor-ticoids administration did no affect the incidence of post- extubative laryngeal stridor (RR=0.39, 95%CI 0.13~1.21). Conclusion Intravenous injection of glucocorticoids can reduce the incidence of post- extubative laryngeal stridor and reintubation in critical il adults with high risk.
