【摘要】 目的 系统评价俯卧位通气(PPV)对急性呼吸窘迫综合征(ARDS)患者预后的影响。方法 检索美国国家医学图书馆PubMed数据库、Web of Science,Cochrane系统评价和临床试验数据库、生物医学与药理学文摘数据库(EMBASE)、中国生物医学文献数据库(CBM)和中国期刊网全文数据库(CNKI)等数据库,系统收集相关随机对照临床试验(RCT)文献。按Cochrane系统评价方法筛选试验、评价质量、提取资料,采用RevMan5.1软件进行Meta分析。结果 最终纳入10项临床对照试验,共2187例患者,全部为随机对照试验,研究质量为B或C。荟萃分析结果显示,与对照组比较,PPV可明显提高ARDS患者氧合指数(6 h氧合指数比较:MD=28.19,95%CI为12.39~43.98,P=0.0005;4 d氧合指数比较:MD=22.34,95%CI为10.77~33.91,P=0.0002;10 d氧合指数比较:MD=18.07,95%CI为3.50~32.64,P=0.02)。与对照组比较,PPV能够降低总体死亡率(OR=0.75,95%CI为0.59~0.96,P=0.02),但ICU死亡率(OR=0.74,95%CI为0.51~1.05,P=0.09)、28 d死亡率(OR=0.75,95%CI为0.44~1.29,P=0.30)、90 d死亡率(OR=0.69,95%CI为0.30~1.60,P=0.39)及6个月死亡率(OR=0.88,95%CI为0.62~1.26,P=0.49)两组比较差异均无统计学意义。PPV组住ICU天数与对照组比较差异有统计学意义(MD=1.43,95%CI为0.38~2.48,P=0.007),而机械通气天数(受访90 d)两组比较差异无统计学意义(MD=-0.42,95%CI为-1.56~0.72,P=0.47)。PPV组呼吸机相关肺炎发生率与对照组比较差异无统计学意义(OR=0.83,95%CI为0.62~1.13,P=0.24),压疮发生率PPV组高于对照组(OR=1.36,95%CI为1.06~1.74,P=0.01),意外拔管发生率两组比较差异无统计学意义(OR=0.94,95%CI为0.62~1.42,P=0.75),气胸发生率两组比较差异无统计学意义(OR=0.75,95%CI为0.45~1.25,P=0.27)。结论 应用PPV治疗ARDS患者能明显提高氧合指数,降低总死亡率,尤其对于重度ARDS患者,可明显改善预后。更多还原

【Abstract】 Objective To evaluate the impact of prone position ventilation（PPV） on the prognosis of acute respiratory distress syndrome（ARDS）.Methods Databases,such as PUBMED,Web of Science,Cochrane Library,EMbase,China National Knowledge Infrastructure（CNKI）,China Biology Medicine（CBM）,were searched to retrieve the randomized controlled trials（RCT） about the impact of PPV on the prognosis of ARDS.Then the retrieved trials were screened by the method of Cochrane systematic review,the data were extracted,the quality of the included studies was evaluated,and Meta-analysis was performed by using the Cochrane Collaborations RevMan5.1 software.Results Ten RCTs with the evaluated quality of B or C were included,and these RCTs totally involve 2187cases.Compared with control group,PPV can significantly improve the oxygenation index（PaO₂/FiO₂）of patients with ARDS（six hours after PPV,MD=28.19,95%CI was 12.39 to 43.98,P =0.0005;4days later,MD=22.34,95%CI was 10.77 to 33.91,P=0.0002;10 days later,MD = 18.07,95%CI was 3.50 to 32.64,P = 0.02）.PPV significantly lowered the total mortality（OR=0.75,95%CI was 0.59 to 0.96,P = 0.02）.But there was no significant difference in the other mortality rate when compared to control（the mortality rate in ICU:OR = 0.74,95%CI 0.51 to 1.05,P = 0.09;the mortality rate in 28 days:OR = 0.75,95%CI was 0.44 to 1.29,P = 0.30;the mortality rate in 90days:OR = 0.69,95%CI was 0.30 to 1.60,P = 0.39;the mortality rate in 6 months:OR = 0.88,95%CI was 0.62 to 1.26,P = 0.49）.Hospital stays in ICU were markedly different in PPV（MD =1.43,95%CI was 0.38 to 2.48,P = 0.007） and control group,but the time of mechanical ventilation were not different between the two groups（MD =-0.42,95%CI was- 1.56 to 0.72,P = 0.47）.The incidence of ventilator- associated pneumonia was not significantly different（OR = 0.83,95%CI was0.62 to 1.13,P = 0.24）.The incidence of bedsore was remarkably higher in PPV groups（OR = 1.36,95%CI was 1.06 to 1.74,P =0.01）.The incidence of unplanned extubation（OR=0.94,95%CI was0.62 to 1.42,P = 0.75）,and the incidence of pneumothorax（OR =0.15,95%CI was 0.45 to 1.25,P = 0.27） showed no significantly difference between the two groups.Conclusion PPV can significantly improve the oxygenation index（PaO₂/FiO₂） of patients with ARDS,and may also reduce the total mortality rate,thus improve the prognosis of ARDS significantly.更多还原