Effects of two different subglottic secretion drainaging methods on ventilator⁃associated pneumonia and tracheal mucosal injury in patients with mechanical ventilation：a meta⁃analysis
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摘要:
目的：评价持续声门下吸引与间断声门下吸引对呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）预防及对气管黏膜损伤的影响。方法：计算机检索PubMed、Cochrane library、Web of Science、Science Direct、EMBASE、中国知网、万方数据库、维普数据库中机械通气患者持续声门下吸引与间断声门下吸引比较的随机对照试验，检索时限均从建库至2019年3月31日。由2位评价员独立筛选文献提取资料并评价纳入研究的偏倚风险后，采用Review Manager 5.3及Stata15.1软件进行meta分析。结果：共纳入9项研究，865例患者。meta分析结果显示，与间断声门下吸引相比，持续声门下吸引VAP发生率［RR=1.06，95%CI（0.88~1.28），P=0.53］、早发VAP发生率［RR=1.09，95%CI（0.66~1.79），P=0.74］、机械通气时间［MD=0.12，95%CI（-0.49~0.72），P=0.70］、ICU住院时间［MD=-0.16，95%CI（-0.88~0.56），P=0.66］和病死率［RR=0.92，95%CI（0.69~1.23），P=0.58］方面，差异均无统计学意义；持续声门下吸引隐血试验阳性率［RR=2.74，95%CI（1.72~4.37），P<0.000 1］高于间断声门下吸引，差异有统计学意义。结论：持续与间断声门下吸引在预防VAP效果方面无差异，但持续声门下吸引较易致气管黏膜损伤。
Abstract:
Objective：This study aims to evaluate effects of continuous subglottic suction and intermittent subglottic suction on prevention of ventilator-associated pneumonia（VAP）and damage to airway mucosa. Methods：Randomized controlled trials published in PubMed，Cochrane library，Web of Science，Science Direct，EMBASE，CNKI，WANFANG，VIP regarding comparison between continuous and intermittent subglottic secretion drainage were searched from database inception to March 31st，2019. Two reviewers independently screened literatures，extracted data，and evaluated the risk of bias in the included studies，then Review Manager 5.3 and Stata15.1 software were used for meta-analysis. Results：Nine studies enrolling a total of 865 patients were included. The results of meta-analysis showed there were no significant differences in the incidence of VAP［RR=1.06，95%CI（0.88-1.28），P=0.53］，incidence of early-onset VAP［RR=1.09，95%CI（0.66-1.79），P=0.74］，duration of mechanical ventilation［MD=0.12，95%CI（-0.49~0.72），P=0.70］，length of staying in intensive care unit［MD=-0.16，95%CI（-0.88~0.56），P=0.66］and mortality rate［RR=0.92，95%CI（0.69~1.23），P=0.58］ between continuous and intermittent subglottic secretion drainage. The incidence of testing for occult blood［RR=2.74，95%CI（1.72-4.37），P < 0.000 1］ of intermittent subglottic secretion drainage was lower than continuous subglottic secretion drainage. Conclusion：There were no apparent differences between continuous and intermittent subglottic secretion drainage for preventing VAP，but continuous subglottic secretion drainage was easy to damage tracheal mucosa.
