俯卧位通气在儿童急性呼吸窘迫综合征中应用效果的Meta分析被引量：14

Effect of prone position ventilation on acute respiratory distress syndrome in children:a meta-analysis

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摘要目的系统评价俯卧位通气在儿童急性呼吸窘迫综合征中的应用效果。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方、维普等国内外数据库中有关俯卧位通气应用于儿童急性呼吸窘迫综合征的随机对照研究和自身对照试验。经筛选文献,提取资料,评价文献质量,采用RevMan5.3软件进行Meta分析。结果最终共纳入7项研究,5项随机对照试验和2项自身对照试验,包括339例研究对象。Meta分析结果显示,俯卧位通气组患儿的PaO_2[MD=15.78,95%CI (2.29,29.27),P=0.02]、PaO_2/FiO_2[MD=60.82,95%CI(17.73,103.91),P=0.006]、氧指数[MD=-2.89,95%CI (-3.41,-2.36),P <0.001]、平均气道压[MD=-1.77,95%CI (-2.10,-1.44),P<0.001]及死亡率[OR=0.30,95%CI (0.13,0.69),P=0.005]与仰卧位通气组相比,差异具有统计学意义;机械通气时间[MD=-31.45,95%CI(-35.29,-27.61),P<0.001]经亚组分析后,与仰卧位通气组相比,差异具有统计学意义;而PaCO_2[MD=-2.74,95%CI(-5.82,-0.34),P=0.08]、压力性损伤发生率[OR=1.30,95%CI(0.56,3.04),P=0.54]及气管插管脱管发生率[OR=0.64,95%CI(0.17,2.36),P=0.50]与仰卧位通气组相比,差异无统计学意义。结论俯卧位通气能够有效改善急性呼吸窘迫综合征患儿的PaO_2、PaO_2/FiO_2、OI,降低平均气道压,缩短机械通气时间及降低死亡率,对改善患儿预后有利;而对急性呼吸窘迫综合征患儿的PaCO_2、压力性损伤发生率及气管插管脱管发生率无明显影响。 Objective To systematically evaluate the effect of prone position ventilation on acute respiratory distress syndrome in children.Methods We searched databases including Cochrane Library,PubMed,Embase,Web of science,CBM,CNKI,Wanfang and VIP.We included all randomized controlled trials and randomized cross-over trials of prone position ventilation in children with acute respiratory distress syndrome.The studies were selected according to inclusion and exclusion criteria,data were extracted and study quality was appraised.RevMan 5.3 software was used for meta-analysis.Results A total of 7 studies,5 randomized controlled trials and 2 randomized cross-over trials were included,involving 339 patients.The meta-analysis showed significant differences between the group with prone position ventilation and the group with supine position ventilation in terms of PaO2[MD=15.78,95%CI(2.29,29.27),P=0.02],PaO2/FiO2[MD=60.82,95%CI(17.73,103.91),P=0.006],OI[MD=-2.89,95%CI(-3.41,-2.36),P<0.001],mean airway pressure[MD=-1.77,95%CI(-2.10,-1.44),P<0.001],mortality[OR=0.30,95%CI(0.13,0.69),P=0.005],and mechanical ventilation time[MD=-31.45,95%CI(-35.29,-27.61),P<0.001]after subgroup analysis,but no significant difference in terms of PaCO2[MD=-2.74,95%CI(-5.82,-0.34),P=0.08],the incidence of pressure injury[OR=1.30,95%CI(0.56,3.04),P=0.54]and the incidence of tracheal extubation[OR=0.64,95%CI(0.17,2.36),P=0.50].Conclusions Prone position ventilation can effectively improve PaO2,OI,reduce mean airway pressure,shorten mechanical ventilation time and reduce mortality in children with acute respiratory distress syndrome.But there was no significant effect onthe incidence of pressure injury and tracheal extubation.

作者唐龙聂泽坤张小云饶倩宋家祥 Tang Long;Nie Zekun;Zhang Xiaoyun;Rao Qian;Song Jiaxiang(ICU Xuzhou Children's Hospital,Xuzhou Medical University,Xuzhou,221006,China;Department of Neonatology,Xuzhou Children's Hospital,Xuzhou Medical University,Xuzhou,221006,China)

机构地区徐州医科大学附属徐州儿童医院重症医学科徐州医科大学附属徐州儿童医院新生儿内科

出处《现代临床护理》 2020年第9期48-55,共8页 Modern Clinical Nursing

关键词俯卧位通气儿童急性呼吸窘迫综合征 META分析 prone position ventilation pediatric acute respiratory distress syndrome meta-analysis

分类号 R473.72 [医药卫生—护理学]

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参考文献5

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