间歇声门下吸引预防ICU患者呼吸机相关性肺炎的Meta分析

摘要

目的:通过Meta分析明确间歇声门下吸引(Intermittent Subglottic Secretion Drainage,ISSD)预防ICU患者呼吸机相关性肺炎(Ventilator-Associated Pneumonia,VAP)的效果.方法:计算机检索Cochrane Library、Pubmed、EMBASE、Web of Knowledge、中国知网、万方数据库、中国生物医学文献数据库中ISSD对ICU患者VAP影响的随机对照实验,同时纳入文献的参考文献,由2名研究人员独立筛选,提取资料并评价文献质量,对满足纳入标准的文献使用RevMan 5.3进行分析.结果:共纳入9篇文献,其中包括2篇中文,7篇英文,共有1 225例研究对象.经Meta分析结果显示ISSD能明显降低ICU患者VAP发病率,包括早发性和晚发性VAP的发病率,缩短ICU住院时间、机械通气时间和住院时间(P＜0.05),但对病死率影响不显著(P＞0.05).结论:ISSD对VAP的预防具有积极作用,能缩短ICU住院时间、机械通气时间和住院时间,但对于降低病死率效果不显著.%Objective:To evaluate the impact of Intermittent Subglottic Secretion Drainage (ISSD) on VentilatorAssociated Pneumonia (VAP) related to critical illness.Methods:Cochrane Library,Pubmed,Excerpta Medica Database,Web of Knowledge,CBMdisc,CNKI,and Wanfang Database were searched for the Randomized Control Trials (RCTs) on the ISSD effect on VAP prevention,while the reference lists of all included studies were also reviewed.Two authors independently screened all the literatures,extracted data and assessed the quality of included studies.All eligible analyses were performed using Review Manager,Version 5.3.Results:Nine eligible trials with total of 1 225 patients (including 2 Chinese and 6 English paper) were included in the analysis.ISSD could decrease the VAP incidence,including early-onset VAP and late-onset VAP.It also could shorten the ICU days,duration of mechanical ventilation duration and hospital days (P＜0.05),but there was no significant difference in mortality (P＞0.05).Conclusion:ISSD might be associated with lower VAP incidence,but it did not clearly decrease patients' mortality.