【摘要】 目的系统评价不同声门下负压吸引方式对气管插管机械通气患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的预防效果。方法计算机检索Cochrane library、Pub Med、EMBASE、Web of science、CINAHL、中国生物医学文献数据库、中国知网、万方和维普数据资源系统中有关声门下负压吸引对气管插管机械通气患者VAP预防效果的临床对照试验。按照纳入和排除标准筛选文献并进行统计分析。结果最终纳入19篇随机对照试验,共有2 334例气管插管机械通气患者,Meta分析结果显示,持续声门下负压吸引、间歇声门下负压吸引均能降低VAP的发生率和早发及晚发VAP发生率(P<0.05);持续声门下负压吸引联合冲洗液冲洗、间歇声门下负压吸引联合冲洗液冲洗均能降低VAP发生率(P<0.05);两种方式对VAP的预防效果差异无统计学意义(P=0.89)。声门下负压吸引能缩短机械通气时间及ICU住院时间(P<0.05)。结论声门下负压吸引能有效降低机械通气患者VAP的发生率、缩短机械通气时间和ICU住院时间;其中持续性声门下负压吸引与间歇性声门下负压吸引对机械通气患者VAP的预防效果相当。由于评价指标间存在异质性,不同指标纳入合格的研究数目也不足,因此,需要更多大样本、多中心、高质量的随机对照研究加以验证。更多还原

【Abstract】 Objective To systematically evaluate the effects of different subglottic negative pressure suction methods on prevention of ventilator-associated pneumonia in patients with endotracheal intubation and mechanical ventilation. Methods Clinical Controlled trials on the preventive effect of subglottic suction on VAP in patients with endotracheal intubation and mechanical ventilation were searched from Cochrane Library,PubMed,EMBASE,Web of Science,CINAHL,Chinese Biomedical Literature Database,CNKI,Wanfang and VIP data resources system.Literatures were selected according to inclusion and exclusion criteria,and RevMam 5.3 software was used for statistical analysis of selected literatures. Results We included a total of 2 334 patients with mechanical ventilation by tracheal intubation in 19 randomized controlled trials. Meta-analysis results showed that both continuous subglottic suction and intermittent subglottic suction could reduce the incidence of VAP and the incidence of early and late VAP(P<0.05). Continuous subglottic suction combined with flushing and intermittent subglottic suction combined with flushing can reduce the incidence of VAP(P<0.05). There was no significant difference between the two methods(P=0.89). Subglottic negative pressure suction reduced mechanical ventilation duration and length of ICU stay(P<0.05). Conclusion Subglottic negative pressure suction can effectively reduce the incidence of VAP in patients with mechanical ventilation,and shorten the length of mechanical ventilation and ICU stay. Continuous subglottic suction and intermittent pressure suction has similar effect on VAP prevention in patients with mechanical ventilation. Due to the heterogeneity of evaluation indicators and the insufficient number of eligible studies included for different indicators evaluation,more large sample size,multicenter,and high-quality RCT are needed for verification.更多还原