摘要
目的系统性分析早期气管切开和晚期气管切开对急性创伤性脊髓损伤(acute traumatic spinal cord injury,ATSCI)患者转归的影响。方法通过计算机检索万方、中国知网、维普、Pubmed、Embase、Cochrane等数据库,检索不同气管切开时机干预ATSCI患者的前瞻性或回顾性对照研究文献,文献质量评价后,采用Revman5.3软件进行定量合成分析。结果共纳入19项文献,Meta分析显示,早期气管切开对短期死亡率、成功脱机率和手术部位感染率无显著影响(P>0.05),早期气管切开组住院时间、ICU入住时间、气管切开后ICU入住时间、机械通气(mechanical ventilation,MV)时间、气管切开后MV时间和呼吸机相关肺炎发生率低于晚期气管切开组(P<0.05)。倒漏斗图显示,存在发表偏倚可能,逐个剔除文献未引起结果逆转。结论ATSCI患者早期气管切开不影响患者短期死亡率,不会增加感染和脱机失败风险,且可减少患者ICU入住时间、MV时间和住院时间,最佳的气管切开时机仍需随机对照试验进行研究探讨。
Objective To systematically analyze the effects of early tracheotomy and late tracheotomy on the outcome of patients with acute traumatic spinal cord injury(ATSCI).Methods Wanfang,CNKI,VIP,PubMed,EMBASE,Cochrane and other databases were searched,and the prospective or retrospective controlled research literature on the intervention of ATSCI at different time of tracheotomy was searched.After literature quality evaluation,Revman5.3 software was used to conduct quantitative synthetic analysis.Results A total of 19 literatures were included.Meta analysis showed that early tracheotomy had no significant effect on short-term mortality,successful weaning rate and surgical site infection rate(P>0.05).The hospital stay,ICU time,ICU time after tracheotomy,mechanical ventilation(MV)time,MV time after tracheotomy and the incidence of ventilator-associated pneumonia of early tracheotomy group were lower than those in advanced tracheotomy group(P<0.05).The inverted funnel chart showed that there was a possibility of publication bias,and the elimination of the literature one by one did not cause the reversal of the results.Conclusion Early tracheotomy in patients with ATSCI does not affect the short-term mortality,does not increase the risk of infection and weaning failure,and can reduce the ICU time,MV time and hospital stay.The best time of tracheotomy still needs to be studied in a randomized controlled trial.
作者
周昌俊
冯明星
刘杰
王国贤
潘大洋
曾仲韦
陈志辉
ZHOU Chang-jun;FENG Ming-xing;LIU Jie;WANG Guo-xian;PAN Da-yang;ZENG Zhong-wei;CHEN Zhi-hui(Department of Spinal Surgery,the Fourth People's Hospital of Guiyang,Guiyang,Guizhou 550002,China;Department of Orthopedics and Traumatology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 710000,China)
出处
《颈腰痛杂志》
2022年第4期463-468,共6页
The Journal of Cervicodynia and Lumbodynia
