医学新知2024，Vol.34Issue(9) ：1030-1040.DOI:10.12173/j.issn.1004-5511.202406105

振动排痰和人工叩背排痰对重型颅脑损伤患者呼吸机相关性肺炎预防效果的Meta分析

Meta-analysis of effects of vibration sputum expulsion and artificial sputum expulsion on prevention of ventilator-associated pneumonia in patients with severe traumatic brain injury

林伟 赵芳珉 石陈燕 蒲桂荣
医学新知2024，Vol.34Issue(9) ：1030-1040.DOI:10.12173/j.issn.1004-5511.202406105
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  • 万方数据

振动排痰和人工叩背排痰对重型颅脑损伤患者呼吸机相关性肺炎预防效果的Meta分析

Meta-analysis of effects of vibration sputum expulsion and artificial sputum expulsion on prevention of ventilator-associated pneumonia in patients with severe traumatic brain injury

林伟 1赵芳珉 1石陈燕 2蒲桂荣3
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作者信息

  • 1. 西部战区空军医院疾病预防控制科(成都 610065)
  • 2. 西部战区空军医院神经外科(成都 610065)
  • 3. 成都市青羊区妇幼保健计划生育服务中心(成都市青羊区妇幼保健院)保健部(成都 610031)
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摘要

目的 系统评价振动排痰和人工叩背排痰在重型颅脑损伤(severe traumatic brain injury,sTBI)患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)预防中的应用效果.方法 计算机检索PubMed、The Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、中国知网、维普、万方等数据库,搜集振动排痰和人工叩背排痰对sTBI患者VAP预防的相关研究,检索时限均从建库至2024年3月.由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan5.4软件进行Meta分析.结果 共纳入8项研究,其中7项随机对照试验,1项非随机对照试验,包括967例研究对象.研究结果显示,与人工叩背排痰相比,振动排痰能降低VAP发生率[RR=0.49,95％CI(0.37,0.64),P＜0.001]、延后 VAP 发生时间[MD=1.47,95％CI(1.34,1.59),P＜0.0011、缩短住院时间[MD=-6.02,95％CI(-9.76,-2.28),P=0.002]和机械通气时间[MD=-4.89,95％CI(-8.64,-1.13),P=0.01]、提高排痰有效率[RR=1.18,95％CI(1.08,1.28),P＜0.001],但2种排痰方式在sTBI患者死亡率方面没有统计学差异[RR=0.67,95％CI(0.37,1.20),P=0.18].结论 相较于人工叩背排痰,振动排痰对预防sTBI患者VAP的发生、促进有效排痰、加快康复方面具有更好的效果,但受纳入研究质量影响,未来仍需高质量的随机对照试验进一步验证.

Abstract

Objective To systematically evaluate the effects of vibration sputum expulsion and artificial sputum expulsion on preventing ventilator-associated pneumonia(VAP)in patients with severe traumatic brain injury(sTBI).Methods The relevant literature in PubMed,the Cochrane Library,Embase,Web of Science,CBM,CNKI,VIP and WanFang database were searched from inception to March 2024.Related studies on preventing VAP in patients with sTBI using vibration and artificial sputum expulsion were collected.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias for included study.RevMan 5.4 software was used for Meta-analysis.Results A total of 8 studies were included,including 7 randomized controlled trials and 1 non-randomized controlled trial,with 967 study subjects.The Meta-analysis results showed that compared with artificial sputum expulsion,vibration sputum expulsion could reduce the incidence of VAP[RR=0.49,95％CI(0.37,0.64),P＜0.00l],delay the occurrence of VAP[MD=1.47,95％CI(1.34,1.59),P＜0.001],shorten hospitalization time[MD=-6.02,95％CI(-9.76,-2.28),P=0.002]and mechanical ventilation time[MD=-4.89,95％CI(-8.64,-1.13),P=0.01],and improve the effective rate of sputum expulsion[RR=1.18,95％CI(1.08,1.28),P＜0.001].There was no statistically significant difference in mortality rate between the two sputum evacuation methods in sTBI patients.Conclusion Compared to artificial sputum expulsion,vibration sputum expulsion has a better effect on preventing VAP in sTBI patients,promoting effective sputum removal and accelerating recovery.However,due to the quality of the included studies,high-quality randomized controlled trials are still needed for further validation in the future.

关键词

重型颅脑损伤/人工叩背排痰/振动排痰/呼吸机相关性肺炎/Meta分析

Key words

Severe traumatic brain injury/Artificial sputum expulsion/Vibration sputum expulsion/Ventilator-associated pneumonia/Meta-analysis

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出版年

2024
医学新知
武汉大学中南医院,中国农工民主党湖北省委医药卫生工作委员会

医学新知

CSTPCD
影响因子：0.243
ISSN：1004-5511
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