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纤维支气管镜肺泡灌洗辅助治疗重症呼吸机相关性肺炎的Meta分析

Meta-analysis of alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of severe ventilator-associated pneumonia

    摘要
  • 摘要:
    目的 基于Meta分析评价纤维支气管镜（简称纤支镜）肺泡灌洗术辅助治疗重症呼吸机相关性肺炎（VAP）的安全性和有效性。
    方法 系统检索多个中英文数据库（中国知网、万方、维普、SinoMed、PubMed、Cochrane Library、Web of science数据库）建库以来的关于纤支镜治疗重症VAP的随机对照试验研究文献，采用Revman 5.4软件进行数据分析。
    结果 本研究共检索到531篇文献，经筛选最终纳入26篇文献，包括2 121例患者，其中试验组1 060例（采用西医常规治疗加常规吸痰治疗）、对照组1 061例（采用西医常规治疗加纤支镜肺泡灌洗术）。Meta分析结果显示，纤支镜肺泡灌洗术辅助治疗重症VAP能够提高临床有效率（RR=1.26，95%CI为1.19~1.32，P < 0.001），降低病死率（RR=0.40，95%CI为0.20~0.79，P=0.009），缩短ICU入住时间（MD=-3.87，95%CI为-4.50~-3.25，P < 0.001），缩短住院时间（MD=-4.05，95%CI为-5.30~-2.79，P < 0.001），缩短机械通气时间（MD=-3.81，95%CI为-4.25~-3.36，P < 0.001），降低急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分（MD=-3.18，95%CI为-4.79~-1.57，P < 0.001），降低临床肺部感染评分（MD=-1.72，95%CI为-2.26~-1.19，P < 0.001），缩短感染控制时间（MD=-4.69，95%CI为-5.14~-4.25，P < 0.001）。
    结论 纤支镜肺泡灌洗术辅助治疗重症VAP在提高临床有效率、降低病死率、缩短住院时间、缩短机械通气时间等方面均优于常规吸痰治疗，且安全有效。

     

    Abstract:
    Objective To evaluate the efficacy and safety of alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of ventilator-associated pneumonia(VAP) based on meta-analysis.
    Methods A number of Chinese and English databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Web of Science) were systematically retrieved for literature on randomized controlled trials of fiberoptic bronchoscopy in the treatment of severe VAP from the database establishment, and the data were analyzed using Revman 5.4 software.
    Results A total of 531 literature were searched, and a total of 26 literatures were finally selected. There were 2 121 patients were included in the study, with 1 060 in trial group(routine treatment of western medicine and conventional sputum suction treatment) and 1 061 in control group(conventional treatment of western medicine and alveolar lavage by fiberoptic bronchoscopy). The results of meta-analysis showed that alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of VAP could improve clinical efficiency (RR=1.26, 95%CI, 1.19 to 1.32, P < 0.001), reduce mortality(RR=0.40, 95%CI, 0.20 to 0.79, P=0.009), shorten ICU stay (MD=-3.87, 95%CI, -4.50 to -3.25, P < 0.001), shorten hospital stay (MD=-4.05, 95%CI, -5.30 to -2.79, P < 0.001), shorten mechanical ventilation time (MD=-3.81, 95%CI, -4.25 to -3.36, P < 0.001), reduce Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score(MD=-3.18, 95%CI, -4.79 to -1.57, P < 0.001), reduce clinical pulmonary infection score (MD=-1.72, 95%CI, -2.26 to -1.19, P < 0.001), shorten time of infection control (MD=-4.69, 95%CI, -5.14 to -4.25, P < 0.001).
    Conclusion Alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of VAP is better in improving the clinical effective rate, reducing the mortality, shortening the length of hospital stay and duration of mechanical ventilation, and it is safe and effective.

     

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