压力控制通气与容量控制通气在俯卧位手术患者气体交换功能的Meta分析

王伟伟; 高巨; 颜克实; 于大朋

doi:10.7619/jcmp.201914016

压力控制通气与容量控制通气在俯卧位手术患者气体交换功能的Meta分析

Effect of pressure control ventilation versus volumecontrol ventilation for surgical patients in prone position: a Meta-analysis

摘要

摘要:
目的采用Meta分析比较压力控制通气(PCV)与容量控制通气(VCV)在围术期俯卧位通气的效果。
方法计算机检索建库至2018年3月1日PubMed、EMbase、The Cochrane Library、WanFang Data数据库，收集俯卧位手术机械通气中应用PCV与VCV通气模式的随机对照试验(RCT)。2名研究者分别进行数据收集、文献筛选，并采用Cochrane协作网系统对纳入文献进行质量评价，应用RevMan 5.3软件进行Meta分析。
结果最终纳入7个RCT, 共计267例患者，其中PCV组134例, VCV组133例。与VCV组比较, PCV组术中俯卧位气道峰压(WMD=-2.08 cmH₂O, 95% CI: -2.78~-1.34 cmH₂O)以及气道平台压(WMD=-1.49 cmH₂O, 95%CI: -2.81~-0.17 cmH₂O)显著降低，且PCV组术中肺动态顺应性(WMD=5.36 mL/cmH₂O, 95% CI: 3.47~7.25 mL/cmH₂O)显著改善，气道平均压(WMD=0.77 cmH₂O, 95% CI: 0.10~1.45 cmH₂O)较高。
结论相比VCV模式，俯卧位机械通气选择PCV模式能维持相对稳定的气道参数，减少气道相关并发症的发生率。

Abstract:
Objective To compare the efficacy of pressure control ventilation(PCV) versus volume control ventilation(VCV) for surgical patients in prone position.
Methods The random control trials(RCT) were searched in the database of PubMed, EMbase, The Cochrane Library, WanFang for the efficacy of PCV versus VCV for surgical patients in prone position. Two researchers collected and screened the data separately, the quality of studies was evaluated by using the Cochrane Collaboration′s net work, and Meta analysis was performed by RevMan 5.3 software.
Results Seven RCTs with a total of 267 patients, of whom 134 received PCV and 133 received VCV, in accordance with the criteria were included in the study. Compared with VCV group, PCV group had reduced intraoperative peak airway pressure(WMD=-2.08 cmH₂O, 95%CI: -2.78~-1.34 cmH²O), plateau airway pressure(WMD=-1.49 cmH₂O, 95%CI: -2.81~-0.17 cmH₂O), improved intraoperative dynamic compliance(WMD=5.36 mL/cmH₂O, 95%CI: 3.47~7.25 mL/cmH₂O), as well as higher mean airway pressure(WMD=0.77 cmH₂O, 95% CI: 0.10~1.45 cmH₂O).
Conclusion Compared with VCV, PCV can maintain a stable airway pressure and reduce airway-related complications for surgical patients with mechanical ventilation in prone position.

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