摘要
目的评价封闭式吸痰系统（CTSS）和开放式吸痰系统（OTSS）用于机械通气患者的临床效果与安全性。方法以计算机和手工检索全面收集国内外关于CTSS和OTSS用于机械通气患者的RCT，按Cochrane系统评价的方法，筛选文献、评价纳入文献质量，使用RevMan5．1软件进行统计分析。结果（1）共检索到相关文献51篇，评价后纳入12项研究，共2384例患者，其中CTSS组1205例，OTSS组1179例。（2）Meta分析结果显示：①临床效果：与OTSS比，CTSS能缩短ICU患者的机械通气时间（WMD=-0．73，95％CI-1．07～-0．40，P〈0．0001），但呼吸机相关性肺炎（VAP）的发病率、呼吸道微生物定植率、住ICU时间、病死率2组间差异无统计学意义（P值均〉0．05）；②安全性：与OTSS比，CTSS能显著降低心律失常的发生率（RR=0．23，95％C10．07—0．74，P=0．01），并能减轻吸痰操作对心率波动（WMD=-1．97，95％CI-3．03～-0．91，P=0．0003）、平均动脉压波动（WMD=-2．01．95％CI-3．02--1．01。P〈0．0001）、指端血氧饱和度波动（WMD=-1．00，95％CI-1．14～-0．86。P〈0．00001）的影响。结论与OTSS比，CTSS能减轻吸痰操作对呼吸、循环系统的干扰，具有良好的安全性，并有助于缩短ICU患者的机械通气时间，但其在预防VAP发生及气道微生物定植、缩短住ICU时间、改善机械通气患者预后方面并无优势。
Objective To evaluate the effects and safety of closed tracheal suction system （CTSS） versus open tracheal suction system （OTSS） for mechanically ventilated patients. Methods All randomized controlled trials （RCTs） comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval. All related data were extracted. Meta analysis was conducted using the statistical software RevMan 5. 1 on the basis of strict quality evaluation with the methods recommended by the Coehrane Collaboration. Results Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included. The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation （ WMD = - O. 73,95% CI - I. 07- - 0. 40, P 〈 0. 0001 ）, but the incidence of ventilator associated pneumonia and microbial colonization, mortality and length of ICU stay exhibited no difference between the two groups （ P 〉 O. 05 ） . However, compared with OTSS, CTSS reduced the incidence of arrhythmia （ RR = 0. 23, 95% CI O. 07-0. 74, P = 0. 01 ） and minimized the disturbance to heart rate （WMD= -1.97, 95% CI - 3.03-- 0.91, P = 0.0003） , mean arterial pressure （WMD = - 2.01, 95%CI -3.02--1.01,P〈0.0001） and oxygen saturation （SpO2） （WMD = -1.00,95%CI -1.14- - 0. 86, P 〈 0. 000 01 ）. Conclusions Compared with OTSS, CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation. However, CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization, nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第10期763-768,共6页
Chinese Journal of Internal Medicine
基金
国家自然科学基金（81070049）
江苏省“科教兴卫工程”医学重点学科项目（889-KJXW11.3）
国家临床重点专科建设项目（2100299）
卫生公益性,厅业科研专项经费项目（201202011）
关键词
封闭式吸痰系统
开放式吸痰系统
呼吸
人工
治疗结果
安全
META
分析
Closed tracheal suction system
Open tracheal suction system
Respiratory, artificial
Treatment outcome
Safety
Meta-analysis
