俯卧位通气治疗急性呼吸窘迫综合症的meta分析

发布时间：2018-12-15 10:35

【摘要】：目的:本研究主要是系统评价俯卧位通气与常规仰卧位通气相比，能否改善急性肺损伤和急性呼吸窘迫综合症的病死率，以及不良事件发生率。 方法:广泛收集俯卧位通气用于治疗成人急性肺损伤/急性呼吸窘迫综合症患者的临床随机对照试验，检索数据库Cochrane Library、PubMed、EMBASE、Web of Science和中国生物医学文献数据库,检索方法采用MeSH主题词检索、自由词检索以及布尔逻辑运算连接词结合的方式,对纳入文献的参考文献进行二次检索。对所得文献依据纳入与排除标准进行审核，并评价文献质量。对纳入文献提取基线数据、病死率、不良事件发生率，并用RevMan5.2.6软件进行分析，病死率合并效应值采用RD值，不良事件发生率采用OR值。 结果:入选5篇文献，共1024位患者，病死率合并效应值RD为-0.12，95%CI[-0.18,-0.06],Z=4.12(P 0.0001)。气胸发生率效应值OR为1.12,95%CI[0.59,2.11],Z=0.34(P=0.73),气管导管意外发生率效应值OR为1.61，95%CI为[1.03,2.49],Z=2.11(P=0.03)。 结论:与常规仰卧位通气相比，，俯卧位通气联合小潮气量（VT≤10ml/kg）、限制平台压（吸气末峰压或平台压≤35cmH2O）的肺保护性通气策略治疗早期ALI/ARDS成人患者，可以降低总体病死率，但气管导管意外发生率增加。
[Abstract]:Objective: to evaluate systematically whether prone position ventilation can improve the mortality and incidence of adverse events in acute lung injury and acute respiratory distress syndrome compared with conventional supine position ventilation. Methods: a randomized controlled trial of prone position ventilation for adult patients with acute lung injury / acute respiratory distress syndrome (ARDS) was widely collected. The database Cochrane Library,PubMed,EMBASE,Web of Science and the Chinese biomedical literature database were searched. The retrieval method uses MeSH subject word retrieval, free word retrieval and Boolean logic operation conjunction to research the references that are included in the literature. Review and evaluate the quality of the literature according to the inclusion and exclusion criteria. The baseline data, mortality and incidence of adverse events were collected from the literature. The combined effect value of case fatality rate and the incidence rate of adverse events were analyzed by RevMan5.2.6 software. The combined effect value of case fatality rate was RD value, and the incidence rate of adverse events was OR value. Results: 1024 patients were included in 5 articles. The mortality combined effect value (RD) was -0.12 卤95 (CI = -0.18 卤0.06), Zu 4.12 (P 0.0001). The incidence effect of pneumothorax was 1.1295 CI [0.59 卤2.11], Z = 0.34 (P < 0.73), OR = 1.61V / 95 CI = 1.03 卤2.49, Z = 2.11 (P = 0.03). Conclusion: compared with conventional supine position ventilation, prone position ventilation combined with low tidal volume (VT 鈮

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