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目的比较有创-无创序贯机械通气模式对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者预后的影响。方法计算机检索Pub Med数据库、Ovid医学数据库、EBSCO全文数据库、中国生物医学文献数据库(CBMdisc)、中文科技期刊数据库(重庆维普)、中国学术期刊数据库(万方数据库)。纳入比较有创-无创序贯机械通气模式和常规有创通气对ARDS治疗有效率的随机对照试验。结果纳入8项研究,病例404例。meta分析结果显示,有创-无创序贯通气组可以使ARDS患者总机械通气时间缩短[(mean difference,MD)=5.85,95%可信区间(confidence interval,CI)(3.62,8.09),P<0.001];降低呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率[相对风险度(relative risk,RR)=0.25,95%CI(0.16,0.39),P<0.001];缩短重症监护室(intensive care unit,ICU)住院时间[MD=5.95,95%CI(5.16,6.73),P<0.001];降低院内病死率[RR=0.35,95%CI(0.22,0.56),P<0.001]。结论有创-无创序贯机械通气策略可能在一定程度上改善ARDS患者的预后。
Objective To compare the effects of invasive and noninvasive sequential mechanical ventilation on the prognosis of patients with acute respiratory distress syndrome (ARDS). Methods We searched PubMed database, Ovid medical database, EBSCO full-text database, CBMdisc, Chinese Science and Technology Periodical Database (Chongqing Vipu) and China Academic Journal Database (Wanfang Database). A randomized controlled trial comparing the more invasive and noninvasive sequential mechanical ventilation and conventional invasive ventilation with ARDS was included. Results Eight studies were included and 404 cases were included. Meta analysis showed that the mean difference (MD) was 5.85, 95% confidence interval (CI) (3.62, 8.09), P <0.001]. The incidence of ventilator associated pneumonia (VAP) was decreased (relative risk RR = 0.25, 95% CI 0.16, 0.39, P 0.001) (MD, 5.95, 95% CI, 5.16, 6.73, P <0.001); reduced in-hospital mortality (RR = 0.35, 95% CI 0.22, 0.56, P 0.001) . Conclusion The invasive-noninvasive sequential mechanical ventilation strategy may improve the prognosis of patients with ARDS to a certain extent.