不同通气模式对单肺通气影响的Meta分析

目的 采用Meta分析的方法评价压力控制通气(pressure controlled ventilation,PCV)与容量控制通气(volume controlled ventilation,VCV)对术中单肺通气(one lung ventilation,OLV)患者呼吸力学及循环的影响. 方法 检索PubMed、Embase、Cochrane图书馆,检索时间从建库至2016年2月.收集术中OLV使用PCV与VCV的临床随机对照试验(randomizedcontrolled trim,RCT).采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan 5.0软件对收集的患者资料进行Meta分析评价. 结果 共纳入14项研究,包括964例患者,其中PCV组480例,VCV组484例.与VCV组比较:在开胸前双肺通气时(T1),PCV组气道平均压(mean airway pressure,Pmean)比值比(odds ratio,OR)0R=-0.22,95％CI(-0.42,-0.01),P＜0.05]较低;OLV时(T2),PCV组气道峰压(peak airway pressure,Ppeak)加权均数差(weighted mean difference,WMD)=-1.37,95％CI(-1.69,-1.05)]及气道平台压(pause pressure,Plateau)较低WMD=-0.29,95％CI(-0.51,-0.07)],而PaO2高WMD=0.52,95％CI(0.08,0.95)];关胸后双肺通气时(T3),PCV组Ppeak较低WMD=-0.63,95％CI(-1.09,0.17)]. 结论 与VCV比较,OLV期间PCV可提供较低的气道压,可能是一种较好的通气模式.

Effects of different ventilation modes on one-lung ventilation: a Meta-analysis

Objective To evaluate the effects of pressure controlled ventilation(PCV) and volume control ventilation(VCV) on the respiratory mechanics and circulation of patients during one-lung ventilation (OLV).Methods We searched the PubMed,Embase and Cochrane libraries for all randomized controlled trials (RCT) from the establishment of library to February 2016 about the use of PCV and VCV during operation.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results A total of 14 studies were selected,including 964 patients (480 for PCV and 484 for VCV).Compared with group VCV,group PCV showed lower mean airway pressure(Pmean) odds ratio(OR)=-0.22,95％CI(-0.42,-0.01),P＜0.05] before chest opening(T1),lower peak airway pressure (Ppeak)weighted mean difference(WMD)=-1.37,95％CI(-1.69,-1.05)],lower plateau pressure(Plateau) airway pressure WMD =-0.29,95％CI(-0.51,-0.07)] but higher pressure of arterial oxygenWMD=0.52,95％CI(0.08,0.95)] during OLV(T2),and lower Ppeak WMD=-0.63,95％CI(-1.09,0.17)] after chest closing(T3).Conclusions Compared with VCV,PCV results in low airway pressure during OLV,which may be a good ventilation model.