呼吸系统弹性阻力对急性肺损伤患者肺复张后氧合影响的荟萃分析

目的 探讨呼吸系统弹性阻力(respiratory system elasticity resistance,Ers)在急性肺损伤(acute lung injury,ALI)患者肺复张过程中氧合的影响.方法 收集1999年1月1日至2010年6月30日关于在肺复张对不同Ers急性肺损伤患者氧合影响的随机对照研究、前瞻观察性研究和病例对照研究,对于肺复张对Ers≥33.3 cmH2O/L(1 cmH2O=0.098 kPa)和Ers＜33.3 cmH2O/L(1 mmHg=0.133 kPa)的ALI患者氧合影响作Meta评价.结果 共281篇文献符合纳入标准,纳入文献共20篇,共纳人患者共395人,结果提示肺复张对高Ers患者氧合改善为(51.97±8.89)mmHg,血压下降(4.33±1.32)mmHg;对低Ers患者氧合改善为(35.13±10.33)mHg,血压下降(0.22±1.03)mmHg,肺复张对两组患者之间氧合改善和血压的影响差异具有统计学意义(P＜0.01).结论 肺复张能够改善ALI患者的氧合,对高Ers的ALI患者氧合改善更为明显;但对高Ers的患者循环影响更为明显.

Abstract：

Objective To investigate the effects of elasticity resistance (Ers) in respiratory system on oxygenation in patients with acute lung injury (ALI) after recruitment maneuvers (RM). Method Meta-analysis of data about the effects of recruitment maneuvers on oxygenation in ALI patients with different elasticity resistances in respiratory system carried out with pooling of study-oriented data stored in Pubmed, Embase, Web of Science databases from January 1999 to June 2010. Results A total of 281 articles were taken, and 20 of them included a sample size of 395 ALI patients. In patients treated with RM in different degrees of respiratory system elasticity resistance ( ≥33.3 cmH2O/L and ＜33.3 cmH2O/L), the effect of RM was better in patients with the high respiratory system elasticity resistance than that with the low one (51.97 + 8.89) mmHg vs. (35.13 ± 10.33 ) mmHg], P ＜ 0. 01 ), but the high respiratory system elasticity resistance was potentially to lower blood pressure (4. 33 ± 1.32 ) mmHg vs. (0.22 ± 1.03 ) mmHg],P ＜ 0.01 ). Conclusions This study suggests RM could improve oxygenation of ALI patients with high respiratory system elasticity resistance, and caution must be made to avoid hypotension during RM.

Effects of respiratory system elasticity resistance on oxygenation after recruitment maneuvers of ALI patients: a meta-analysis

Objective To investigate the effects of elasticity resistance (Ers) in respiratory system on oxygenation in patients with acute lung injury (ALI) after recruitment maneuvers (RM). Method Meta-analysis of data about the effects of recruitment maneuvers on oxygenation in ALI patients with different elasticity resistances in respiratory system carried out with pooling of study-oriented data stored in Pubmed, Embase, Web of Science databases from January 1999 to June 2010. Results A total of 281 articles were taken, and 20 of them included a sample size of 395 ALI patients. In patients treated with RM in different degrees of respiratory system elasticity resistance ( ≥33.3 cmH2O/L and ＜33.3 cmH2O/L), the effect of RM was better in patients with the high respiratory system elasticity resistance than that with the low one (51.97 + 8.89) mmHg vs. (35.13 ± 10.33 ) mmHg], P ＜ 0. 01 ), but the high respiratory system elasticity resistance was potentially to lower blood pressure (4. 33 ± 1.32 ) mmHg vs. (0.22 ± 1.03 ) mmHg],P ＜ 0.01 ). Conclusions This study suggests RM could improve oxygenation of ALI patients with high respiratory system elasticity resistance, and caution must be made to avoid hypotension during RM.