中国实用护理杂志
中國實用護理雜誌
중국실용호리잡지
CHINESE JOURNAL OF PRACTICAL NURSING
2015年
15期
1154-1159
,共6页
郭妙兰%温李滔%郭锦兰%高国贞
郭妙蘭%溫李滔%郭錦蘭%高國貞
곽묘란%온리도%곽금란%고국정
肺炎,呼吸机相关性%Meta分析%持续声门下吸引
肺炎,呼吸機相關性%Meta分析%持續聲門下吸引
폐염,호흡궤상관성%Meta분석%지속성문하흡인
Pneumonia,ventilator associated%Meta-analysis%Continuous aspiration of subglottic suction
目的 系统评价持续声门下吸引(CASS)对机械通气患者呼吸机相关性肺炎(VAP)发生率及其他结局指标的影响.方法 检索1994年7月至2014年7月PubMed、Cochrane Library、Ovid、EBSCOhost、Science Direct、Google Scholar、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方数据库中所有涉及CASS预防机械通气患者VAP效果的随机对照实验(RCT),并辅以手工检索,严格按照纳入、排除标准筛选文献,对符合要求的文献进行质量评价和资料提取,采用RevMan5.1软件进行Meta分析.结果 共纳入7个RCT研究,1 566例患者.使用CASS的机械通气患者与对照组相比,VAP的发生率显著降低(RR=0.54,95％CI0.43～0.65,P＜0.01),VAP发生时间延长(MD=3.52,95％CI1.98～5.06,P＜0.01),机械通气时间缩短(MD=-2.03,95％CI-2.23～-1.73,P＜0.01),入住ICU时间缩短(MD=-2.99,95％CI-3.75～-2.23,P＜0.01).CASS组中发生VAP者日平均引流量较未发生VAP者显著下降(MD=-25.06,95％CI-30.04～-20.08,P＜0.01),但是在死亡率方面比较差异无统计学意义(RR=0.98,95％CI0.80～1.20,P＞0.05).结论 采取CASS能预防机械通气患者VAP的发生,由于有关的RCT数量相对较少、质量欠佳,需要高质量的大规模RCT进一步证实.
目的 繫統評價持續聲門下吸引(CASS)對機械通氣患者呼吸機相關性肺炎(VAP)髮生率及其他結跼指標的影響.方法 檢索1994年7月至2014年7月PubMed、Cochrane Library、Ovid、EBSCOhost、Science Direct、Google Scholar、中國生物醫學文獻服務繫統(CBM)、中國知網(CNKI)、萬方數據庫中所有涉及CASS預防機械通氣患者VAP效果的隨機對照實驗(RCT),併輔以手工檢索,嚴格按照納入、排除標準篩選文獻,對符閤要求的文獻進行質量評價和資料提取,採用RevMan5.1軟件進行Meta分析.結果 共納入7箇RCT研究,1 566例患者.使用CASS的機械通氣患者與對照組相比,VAP的髮生率顯著降低(RR=0.54,95％CI0.43～0.65,P＜0.01),VAP髮生時間延長(MD=3.52,95％CI1.98～5.06,P＜0.01),機械通氣時間縮短(MD=-2.03,95％CI-2.23～-1.73,P＜0.01),入住ICU時間縮短(MD=-2.99,95％CI-3.75～-2.23,P＜0.01).CASS組中髮生VAP者日平均引流量較未髮生VAP者顯著下降(MD=-25.06,95％CI-30.04～-20.08,P＜0.01),但是在死亡率方麵比較差異無統計學意義(RR=0.98,95％CI0.80～1.20,P＞0.05).結論 採取CASS能預防機械通氣患者VAP的髮生,由于有關的RCT數量相對較少、質量欠佳,需要高質量的大規模RCT進一步證實.
목적 계통평개지속성문하흡인(CASS)대궤계통기환자호흡궤상관성폐염(VAP)발생솔급기타결국지표적영향.방법 검색1994년7월지2014년7월PubMed、Cochrane Library、Ovid、EBSCOhost、Science Direct、Google Scholar、중국생물의학문헌복무계통(CBM)、중국지망(CNKI)、만방수거고중소유섭급CASS예방궤계통기환자VAP효과적수궤대조실험(RCT),병보이수공검색,엄격안조납입、배제표준사선문헌,대부합요구적문헌진행질량평개화자료제취,채용RevMan5.1연건진행Meta분석.결과 공납입7개RCT연구,1 566례환자.사용CASS적궤계통기환자여대조조상비,VAP적발생솔현저강저(RR=0.54,95％CI0.43～0.65,P＜0.01),VAP발생시간연장(MD=3.52,95％CI1.98～5.06,P＜0.01),궤계통기시간축단(MD=-2.03,95％CI-2.23～-1.73,P＜0.01),입주ICU시간축단(MD=-2.99,95％CI-3.75～-2.23,P＜0.01).CASS조중발생VAP자일평균인류량교미발생VAP자현저하강(MD=-25.06,95％CI-30.04～-20.08,P＜0.01),단시재사망솔방면비교차이무통계학의의(RR=0.98,95％CI0.80～1.20,P＞0.05).결론 채취CASS능예방궤계통기환자VAP적발생,유우유관적RCT수량상대교소、질량흠가,수요고질량적대규모RCT진일보증실.
Objective To systemically analyze the effect of continuous aspiration of subglottic suction (CASS) on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients.Methods PubMed,Cochrane Library,Ovid,EBSCOhost,ScienceDirect,Google scholar,CNKI,CBM and Wanfang Database were searched for the RCTs about the effect of CASS on the outcomes of mechanical ventilated patients from July 1994 to July 2014,and the relevant journals were also hand-searched.Data were extracted independently by two reviewers.Meta analysis was conducted using RevMan 5.1 software.Results Data extracted from 7 RCTs with a total of 1 566 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients receiving CASS [RR =0.54,95％ CI(0.43,0.65),P＜0.01],episodes of VAP occurred later in patients receiving CASS [MD=3.52,95％CI(1.98,5.06),P＜0.01],the duration of mechanical ventilation [MD=-2.03,95％CI(-2.23,-1.73),P＜0.01]and length of ICU stay were reduced [MD=-2.99,95％CI(-3.75,-2.23),P＜0.01],while no significant differences were detected between the two groups regarding the mortality rate [RR=0.98,95％CI (0.80,1.20),P＞0.05].Conclusion This study proved that the CASS did have effect in reducing the incidence of VAP,but it is limited by lack of enough RCTs with high quality.Large sample of high quality RCTs is necessary to examine the wider applicability of CASS.
