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目的 分析已有的多项临床随机对照试验 (RCT)是否确能说明低潮气量机械通气能降低急性呼吸窘迫综合征 (ARDS)的病死率。方法 用关键词途径从 1990～ 2 0 0 1年MEDLINE数据库和中国生物医学文献数据库光盘进行文献检索 ,将观察对象是ARDS患者、观察时间≥ 10天、比较低潮气量机械通气和传统机械通气疗效的所有临床随机对照研究论文数据作meta分析。结果 7项研究共 1435例患者被纳入 ,其中 5项研究两种疗法之病死率差异无显著意义 ,2项研究的低潮气量治疗组病死率低于传统治疗组。低潮气量治疗组和传统治疗组病死率分别为 35 98% ( 2 5 8/ 717)和42 6 2 % ( 30 6 / 718) ,OR合并0 75 4( 95 %CI 0 6 10～ 0 933) ,P <0 0 1。结论 低潮气量机械通气可降低ARDS病死率 ,值得临床推广应用。
PURPOSE: To analyze whether multiple RCTs are available to demonstrate that low tidal volume mechanical ventilation can reduce the mortality of acute respiratory distress syndrome (ARDS). Methods A literature search of the MEDLINE database from 1990 to 2001 and the Chinese Biomedical Literature Database CD-ROM was performed. The subjects were ARDS patients. The observation time was 10 days. The therapeutic effect of low tidal volume mechanical ventilation and traditional mechanical ventilation All clinical randomized controlled study data for meta-analysis. Results A total of 1435 patients were enrolled in the seven studies. Five of the five studies showed no significant difference in mortality between the two therapies. The mortality of the two studies with low tidal volume was lower than that of the traditional treatment group. The mortality rates of the low tidal volume treatment group and the traditional treatment group were 35 98% (2 58/717) and 42 6 2% (30 6/718), respectively. The odds of OR were 0 75 4 (95% CI 0 6 10-0 933) , P <0 0 1. Conclusion Low tidal volume of mechanical ventilation can reduce ARDS mortality, it is worthy of clinical application.