气道压力释放通气对ARDS患者有效性的Meta分析与试验序贯分析

目的评价气道压力释放通气（APRV）对急性呼吸窘迫综合征（ARDS）患者的有效性。 方法应用计算机检索美国国立医学图书馆PubMed数据库、科学网（Web of Science）、Cochrane图书馆数据库、中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普数据库（VIP）、万方数据库2019年12月31日以前公开发表的关于APRV对ARDS患者疗效的临床随机对照试验，并通过纳入文献的参考文献进行引证检索。试验组采用APRV，对照组采用传统机械通气（CV）；结局指标包括住院病死率、ICU住院时间、肺顺应性、氧合指数及平均气道压。纳入文献的质量由2名经过专业培训的循证医学研究人员完成，对符合质量标准的文献进行Meta分析，同时采用试验序贯分析（TSA）方法评价APRV对ARDS患者住院病死率样本量的情况。 结果纳入8篇文献，共纳入患者461例患者，其中APRV组232例、CV组229例。结果显示APRV能够降低ARDS患者住院病死率（OR=0.63，95%CI=0.40~0.97，P=0.04），TSA结果显示Meta分析的样本量还未达到期望信息量，为避免假阳性结果的出现，还需进一步扩大临床样本量来验证结果的可靠性；APRV能够缩短ARDS患者ICU住院时间（OR=-4.14，95%CI=-6.81~-1.47，P=0.002）；同时APRV能够改善ARDS患者肺部顺应性（MD=5.12，95%CI=0.33~9.91，P=0.04）；但2组在改善氧合及平均气道压方面并无差异。 结论APRV较CV能够降低ARDS患者住院病死率、缩短ARDS患者ICU住院时间、改善肺部顺应性；2组在改善患者氧合及平均气道压方面无差异。

Meta-analysis and trial sequential analysis : The effectiveness of airway pressure release ventilation in patients with acute respiratory distress syndrome

ObjectiveTo evaluate the effectiveness of airway pressure release ventilation in patients with acute respiratory distress syndrome. MethodsWe searched the US National Library of Medicine PubMed database, Web of Science, Cochrane Library Database, China Knowledge Network, China Biomedical Literature Database, VIP and Wanfang Database for randomized controlled clinical trials published before December 31, 2019 on the efficacy of APRV in patients with ARDS, in which the control groups used conventional mechanical ventilation, and the experimental groups used airway pressure release ventilation; outcomes included hospital mortality, ICU hospitalization time, lung compliance, oxygenation index, and mean airway pressures. The quality of the selected literature was evaluated by two professionally trained evidence-based medicine researchers.Meta-analysis was performed on the literature that met the quality criteria. The sequential analysis method was used to evaluate the sample size of the hospitalized mortality rate of ARDS patients treated with APRV. ResultsEight articles were selected and 461 patients were enrolled, with 232 in the APRV group and 229 in the CV group. The results showed that APRV can reduce the mortality of patients with acute respiratory distress syndrome (OR=0.63, 95% CI=0.40~0.97, P=0.04). The TSA results show that in order to avoid the occurrence of false positive results further research is needed, the clinical sample size should be expanded to verify the reliability of the results; APRV can shorten the ICU stay of ARDS patients (OR=-4.14, 95%CI=-6.81~-1.47, P=0.002); APRV can improve Pulmonary compliance in patients with ARDS (MD=5.12, 95%CI=0.33~9.91, P=0.04); but there was no difference in improving oxygenation and mean airway pressure between the two groups. ConclusionAPRV can decrease the mortality of ARDS patients, shorten their ICU stay, and improve their lung compliance. There is not any difference in improving oxygenation and mean airway pressure between the two groups.