温湿交换器对机械通气患者气道湿化效果的Meta分析

发布时间：2018-04-08 11:54

本文选题：温湿交换器　切入点：通气机　出处：《重庆医学》2014年11期

【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、相关期刊论文(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(2 960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%CI0.61~1.01,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(P0.05),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RCT进一步证实该证据。
[Abstract]:Objective to evaluate the safety and efficacy of humidification of temperature and humidity exchanger (HMEs) on artificial airway humidification in patients with mechanical ventilation.Methods the Cochrane Library PubMedembase, China Journal Full-text Database, China Sci-tech Journal Full-text Database, Wanfang Database and Chinese Biomedical Literature Database were searched by computer from the establishment of the database to March 2012.The effect of HMEs on humidification of artificial airway in patients with mechanical ventilation was analyzed by Meta. The results of randomized controlled trial (RCT) and semi-randomized controlled trial (QRCTT) were analyzed by Meta with RevMan5.1.2 software.Results A total of 2,960 patients were enrolled in 19 studies, all of whom were in a randomized parallel controlled trial. Meta-analysis showed that HMEs could not reduce the incidence of ventilator-associated pneumonia (VAPs).Conclusion HMEs can not reduce the incidence of VAP, mortality and the incidence of catheter obstruction, but can reduce the cost of VAP.Because of the risk of bias and the low quality of the evidence, more strictly designed and implemented RCT is needed to further confirm the evidence.
【作者单位】：遵义医学院附属医院急诊科;遵义医学院护理学院;
【基金】：遵义医学院校级重点学科(临床护理学)经费资助
【分类号】：R563.1

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