重型颅脑损伤患者应用密闭式或开放式吸痰效果比较的meta分析

王玢; 丁星星; 孙瑶环; 王慧; 董银凤

doi:10.16766/j.cnki.issn.1674-4152.002919

重型颅脑损伤患者应用密闭式或开放式吸痰效果比较的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.002919

南京中医药大学护理学院，江苏南京 210023

基金项目:

江苏省自然科学基金面上项目 BK20201402

详细信息

通讯作者:
董银凤，E-mail: dongyf@njucm.edu.cn

中图分类号: R651.15
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- 文章访问数: 195
- HTML全文浏览量: 58
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-05
- 网络出版日期: 2023-04-19

Comparison of the effect between closed endotracheal suctioning and open endotracheal suctioning on patients with severe craniocerebral injury: a meta-analysis

School of Nursing Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China

摘要

摘要: 目的系统评价密闭式和开放式吸痰在行机械通气的重度颅脑损伤患者中的应用效果，旨在为其吸痰方式的合理选择提供依据。方法计算机检索PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网、万方、维普及中国生物医学文献数据库，筛选关于密闭式和开放式吸痰对重型颅脑损伤患者干预效果比较的随机对照试验，由2名研究者按照纳排标准独立筛选文献，并进行质量评价和资料提取。最后采用RevMan5.3软件进行meta分析。结果共纳入7项研究，包括462例研究对象。Meta分析结果显示，密闭式吸痰与开放式吸痰相比，可降低吸痰时颅内压(MD=-3.46，95% CI: -4.85~-2.08，P＜0.001)和吸痰后5 min的颅内压(MD=-3.33，95% CI: -3.92~-2.74，P＜0.001)，并增加血氧饱和度(MD=3.95，95% CI: 3.28~4.62，P＜0.001)、提高动脉血氧分压(MD=19.06，95% CI: 12.97~25.15，P＜0.001)及降低呼吸机相关性肺炎的发生率(RR=0.21，95% CI: 0.10~0.43，P＜0.001)；而2种吸痰方式对吸痰后15 min的颅内压、吸痰时和吸痰后脑灌注压的影响差异无统计学意义。结论密闭式吸痰比开放式吸痰更有利于稳定重型颅脑损伤患者的颅内压、血氧饱和度和动脉血氧分压，并降低呼吸机相关性肺炎的发生率。
- 重型颅脑损伤 /
- 密闭式吸痰 /
- 开放式吸痰 /
- Meta分析
Abstract: Objective To systematically evaluate the effects of closed and open endotracheal suctioning on patients with severe craniocerebral injury and provide scientific evidence for their selection. Methods We searched databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP database and China Biology Medicine Disc (CBM), for randomised controlled trials of closed and open endotracheal suctioning on patients with severe craniocerebral injury. Studies were independent selected by two researchers in accordance with the inclusion and exclusion criteria. Then, data were extracted, and the quality of literature was evaluated. Finally, RevMan 5.3 software was used to meta-analysis. Results Seven randomised controlled trials including 462 patients were included. The results of meta-analysis showed that the closed endotracheal suctioning was significantly superior to open endotracheal suctioning in decreasing intracranial pressure during suctioning (MD=-3.46, 95% CI: -4.85 to -2.08, P < 0.001) and at 5 min after suctioning (MD=-3.33, 95% CI: -3.92 to -2.74, P < 0.001), increasing SpO₂ (MD=3.95, 95% CI: 3.28-4.62, P < 0.001) and PaO₂(MD=19.06, 95% CI: 12.97-25.15, P < 0.001), and reducing the incidence of ventilator-associated pneumonia (RR=0.21, 95% CI: 0.10-0.43, P < 0.001). However, no significant influence on intracranial pressure was observed at 15 min after suctioning and on cerebral operfusion pressure during or after suctioning. Conclusion Compared with open endotracheal suctioning, closed endotracheal suctioning is more conductive to stabilising intracranial pressure, SpO₂ and PaO₂ and reducing the incidence of ventilator-associated pneumonia in patients with severe craniocerebral injury.
- Severe craniocerebral injury /
- Closed endotracheal suctioning /
- Open endotracheal suctioning /
- Meta-analysis

HTML全文

图 1 密闭式与开放式吸痰患者ICP比较的meta分析

Figure 1. Meta-analysis of ICP in patients with closed versus open suction

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图 2 密闭式与开放式吸痰患者SpO₂比较的meta分析

Figure 2. Meta-analysis of the comparison of SpO₂ between closed and open suction patients

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图 3 密闭式与开放式吸痰患者PaO₂比较的meta分析

Figure 3. Meta-analysis of PaO₂ in patients with closed versus open sputum aspiration

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图 4 密闭式与开放式吸痰VAP发生率比较的meta分析

Figure 4. Meta-analysis of the incidence of VAP between closed and open suction

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图 5 密闭式与开放式吸痰患者CPP比较的meta分析

Figure 5. Meta-analysis of CPP in patients with closed versus open suction

下载: 全尺寸图片幻灯片

表 1 纳入文献基本特征

Table 1. Basic characteristics of the included literature

纳入文献	年份	样本量(例)		干预方法		结局指标
纳入文献	年份	观察组	对照组	观察组	对照组	结局指标
沈丽华等^[10]	2020	48	48	密闭式	开放式	ICP、PaO₂、VAP发生率、动脉二氧化碳分压
曹艳佩等^[11]	2011	39	40	密闭式	开放式	ICP、CPP、SpO₂
冯全吉等^[12]	2011	25	25	密闭式	开放式	痰量、SpO₂、VAP发生率
成异清等^[13]	2010	25	26	密闭式	开放式	SpO₂
姜雪凤^[14]	2018	30	30	密闭式	开放式	痰量、SpO₂、VAP发生率
邓春梅等^[15]	2017	47	47	密闭式	开放式	ICP、心率、痰鸣音
UǦRAŞ G A等^[16]	2012	16	16	密闭式	开放式	ICP、平均动脉压、CPP、PaO₂、动脉二氧化碳分压

下载: 导出CSV

表 2 纳入文献研究方法学质量评价

Table 2. Evaluation of methodological quality of included literature studies

纳入文献	随机序列生成	分配隐藏	实施者及参与者盲法	结果测评者盲法	数据的完整性	选择性报告结果	其他偏倚
沈丽华等^[10]	低偏倚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
曹艳佩等^[11]	低偏倚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
冯全吉等^[12]	不清楚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
成异清等^[13]	不清楚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
姜雪凤^[14]	不清楚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
邓春梅等^[15]	不清楚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚
UǦRAŞ G A等^[16]	不清楚	高偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚

下载: 导出CSV

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