温湿交换器对机械通气患者气道湿化效果的Meta分析

摘要

目的：评价温湿交换器湿化法（HMEs）对机械通气患者人工气道湿化的安全性和有效性。方法计算机检索 the Cochrane Library、PubMed、Embase、中国期刊全文数据库（CNKI）、中国科技期刊全文数据库（VIP）、万方数据库、中国生物医学文献数据库（CBM）从建库至2012年3月的相关文献，纳入HMEs对机械通气患者人工气道湿化效果的随机对照试验（RCT）和半随机对照试验（qRCT），用RevMan5．1．2软件对 HMEs与加热湿化器湿化法（HHs）进行Meta分析。结果共纳入19个研究（2960例患者），均为随机平行对照试验。Meta分析结果显示，HMEs不能降低呼吸机相关性肺炎（VAP）的发生率[相对危险度（RR）＝0．78，95％ CI 0．61～1．01，P＝0．06]，也不能降低住院病死率（RR＝0．94，95％ CI 0．83～1．08，P＝0．40）、重症监护病房（ICU）住院时间[均数差（MD）＝-0．32，95％ CI -3．13～2．50，P＝0．82]及导管阻塞发生率（RR＝0．65，95％ CI 0．22～1．93， P＝0．44），HMEs、HHs两组比较差异均无统计学意义（P＞0．05），但有5个研究报道使用 HMEs能减少患者费用。结论HMEs不能降低VAP发生率、病死率、ICU住院时间及导管阻塞发生率，但能减少患者费用。由于所纳入研究均存在偏倚风险，所得证据质量低，因此需要更多严格设计和实施的RC T进一步证实该证据。%Objective To assess the effectiveness and safety of heat moisture exchangers (HMEs) on the artificial airway humid-ification in the mechanically ventilated patients .Methods The related literature in the Cochrane Library ,PubMed ,Embase ,CNKI , VIP ,WanFang database and CBM from the establishment to March 2012 were retrieved ,then included the randomized controlled trial(RCT) and quasi-RCT on the effect of HMEs for the artificial airway humidification in the mechanically ventilated patients were performed the meta analysis by using RevMan 5 .1 .2 software .Results 19 RCT were included(involving 2 960 patients) , which were the random parallel controlled trials .The meta analysis results showed that HMEs could not reduce the incidence rate of ventilator-associated pneumonia(VAP)(RR=0 .78 ,95% CI 0 .61-1 .01 ,P=0 .06) ,also could not decrease the hospitalization mor-tality(RR=0 .94 ,95% CI 0 .83-1 .08 ,P=0 .40) ,the length of ICU stay(MD= -0 .32 ,95% CI -3 .13 -2 .50 ,P=0 .82) and the occurrence rate of catheter occlusion (RR=0 .65 ,95% CI 0 .22 -1 .93 ,P= 0 .44) ,the differences between the two groups had no statistical significance .But 5 RCT reported that using HMEs could reduce the patient′s costs .Conclusion HMEs can not reduce the incidence rate of VAP ,mortality ,length of ICU stay ,occurrence rate of airway occlusion ,but can cut down the patient′s cost . Due to the risk of bias existing in all included RCT and the low quality of the obtained evidences ,more strictly designed and imple-mented RCTs are needed to further verify thse evidences .