俯卧位通气对急性肺损伤和急性呼吸窘迫综合征临床疗效影响的Meta分析

目的 系统评价俯卧位通气(PPV)对我国急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)患者的短期临床疗效.方法 利用Cochrane系统评价法,全面检索2000年至2009年国内公开发表的所有ALI与ARDS患者PPV的临床研究资料.对纳入研究独立进行质量评价、资料提取、交叉核对后行Meta分析.结果 纳入研究8项共184例患者,PPV时患者动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、呼吸系统总顺应性(C)均显著升高;动脉血二氧化碳分压(PaCO2)、中心静脉压(CVP)、呼吸道峰压(PIP)和呼吸系统总阻力(Raw)无显著的变化;心率(HR)与平均动脉压(MAP)显著升高. 结论 ALI与ARDS患者行PPV可增加呼吸系统总顺应性,改善患者低氧血症,相关临床研究结果基本一致.但因Meta分析的自身局限性,我们仍急需开展设计严谨的高质量大样本临床研究,明确PPV临床疗效、作用机制、科学的操作流程及PPV对患者血流动力学的影响等临床实际问题,改善国内ALI与ARDS患者的临床护理水平.

Meta-analysis of clinical effect of prone position ventilation in patients with acute lung injury/acute respiratory distress syndrome

Objective To systematically evaluate the short clinical effect of prone position ventilation (PPV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods All relative literatures published in the past nine years were searched by computer and hands. Quality appraisal and review data extraction of searched literatures were completed and underwent Meta analysis. Results Eight studies including 184 patients with ALI/ARDS were brought into this Meta-analysis according to the inclusion and the exclusion criteria. Oxygen in artery(PaO2) 、oxygen index (PaO2/FiO2)、pulmonary compliance (C) increased during prone position ventilation, partial pressure of dioxide in artery (PaCO2)、central venous pressure (CVP) 、peak inspiratory pressure ( PIP)、airway resistance (Raw) showed no change, heart rate (HR) and mean artery pressure (MAP) both increased. Conclusions Pulmonary compliance and hypoxemia of patients with ALI/ARDS is improved markedly in PPV. While, due to some limitations of this Meta-analysis, high quality study on PPV is still needed to make clear the clinical effect, mechanism and scientific procedure of PPV and influence of PPV on hemodynamics of patients, so that we can improve the nursing level of patients with ALI/ARDS.