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目的 :评价自动调节气囊压力在预防呼吸机相关性肺炎(VAP)中的应用效果。方法 :系统检索The Cochrane Library、Pubmed、EMBASE、中国生物医学文献服务系统(CBM)、维普数据库(VIP)、中国期刊全文数据库(CNKI)以及万方数据库,同时检索相关原始文献和综述文献中所附的参考文献。2名研究者独立检索文献、筛选文献、提取资料、评价纳入文献的方法学质量,采用Rev Man 5.3软件进行Meta分析和敏感性分析。结果 :共纳入6篇文献,5篇为随机对照试验,1篇为半随机对照试验。Meta分析结果显示,与定期监测气囊压力相比,自动调节气囊压力可将压力维持在20~30cm H2O,降低大量误吸的发生率[RR=0.53,95%CI(0.40~0.69)]及VAP的发生率[RR=0.56,95%CI(0.42~0.75)],但是对患者机械通气时间[MD=-1.96,95%CI(-5.82~1.89)]、ICU住院日[MD=-1.22,95%CI(-6.08~3.63)]、病死率[RR=0.94,95%CI(0.68~1.28)]没有明显改善。结论:自动调节气囊压力可将气囊压力维持在合适的范围,从而减少大量误吸,降低VAP的发生率,但是对患者的预后没有明显改善。
PURPOSE: To evaluate the effect of automatically adjusting balloon pressure in the prevention of ventilator-associated pneumonia (VAP). Methods: The Cochrane Library, Pubmed, EMBASE, CBM, VIP, CNKI and Wanfang databases were searched systematically. At the same time, relevant original and review articles were searched Attached to the reference. Two researchers independently searched the literature, screened the literature, extracted data, evaluated the methodological quality of the included literature, and performed meta-analyzes and sensitivity analyzes using RevMan 5.3 software. RESULTS: Six articles were included, five were randomized controlled trials and one was a semi-randomized controlled trial. Meta-analysis showed that, compared with regular monitoring of balloon pressure, automatic adjustment of balloon pressure could maintain the pressure at 20-30 cm H2O and reduce the incidence of massive aspiration (RR = 0.53, 95% CI 0.40-0.69) and VAP (RR = 0.56, 95% CI, 0.42-0.75). However, the duration of mechanical ventilation (MD = -1.96,95% CI -5.82-1.89) and ICU stay [MD = -1.22, 95% CI (-6.08-3.63)]. The mortality rate [RR = 0.94, 95% CI (0.68-1.28)] showed no significant improvement. CONCLUSIONS: Auto-adjusting balloon pressure maintains the balloon pressure within a reasonable range, thereby reducing the number of aspiration and reducing the incidence of VAP, but with no significant improvement in patient outcome.