目的对神经重症气管切开患者的拔管指征进行Meta分析,以确定这些患者拔管成功的有效指征参数。方法对中国知网、万方数据、维普数据库、科学网(Web of Science)、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库进行文献检索;检...目的对神经重症气管切开患者的拔管指征进行Meta分析,以确定这些患者拔管成功的有效指征参数。方法对中国知网、万方数据、维普数据库、科学网(Web of Science)、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库进行文献检索;检索时限均从建库至2019年4月。检索文献为有关神经重症气管切开患者拔管过程中拔管指征参数的病例对照研究、队列研究、随机对照试验(RCT)或调查。由2位研究者独立识别并筛选文献、提取数据,使用纽卡斯尔-渥太华量表(NOS)评估纳入文献质量,采用RevMan 5.3软件进行Meta分析。通过评估统计模型(固定效应模型或随机效应模型)、研究文献质量(低质量或高质量)是否会影响结果,进行敏感性分析以评估结果的稳定性;通过漏斗图定性评价纳入文献的发表偏倚。结果共纳入11项研究,涉及1357例患者。报告的神经重症气管切开患者拔管成功率为46.7%~97.5%;9项研究中拔管成功的定义是无再插管,另外2项未说明;所有研究NOS评分为6~8分,均为高质量研究。Meta分析显示,神经重症气管切开患者的意识水平〔格拉斯哥昏迷评分(GCS)≥8分比<8分:优势比(OR)=3.34,95%可信区间(95%CI)为2.22~5.03,P<0.001〕、气管分泌物量(少比多:OR=13.07,95%CI为5.64~30.32,P<0.001)、咳嗽反射(有比无:OR=14.33,95%CI为6.36~32.28,P<0.001)和吞咽功能(良比差:校正OR=18.56,95%CI为8.16~42.21,P<0.001)与拔管结果的相关性有统计学意义;而肺部感染(无比有:校正OR=1.94,95%CI为0.87~4.35,P=0.11)、血氧饱和度(≥0.95比<0.95:OR=2.34,95%CI为1.11~4.91,P=0.12)、堵管耐受性(良比差:OR=2.12,95%CI为0.67~6.71,P=0.20)及拔管方式(渐进比直接:OR=0.99,95%CI为0.95~1.04,P=0.93)与拔管结果的相关性无统计学意义。敏感性分析显示结果稳定。漏斗图显示,纳入研究对称分布于漏斗两侧,提示存在发表偏倚的可能性较小。结论神经重症气管切开患者有展开更多
BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noni...BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.展开更多
文摘目的对神经重症气管切开患者的拔管指征进行Meta分析,以确定这些患者拔管成功的有效指征参数。方法对中国知网、万方数据、维普数据库、科学网(Web of Science)、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库进行文献检索;检索时限均从建库至2019年4月。检索文献为有关神经重症气管切开患者拔管过程中拔管指征参数的病例对照研究、队列研究、随机对照试验(RCT)或调查。由2位研究者独立识别并筛选文献、提取数据,使用纽卡斯尔-渥太华量表(NOS)评估纳入文献质量,采用RevMan 5.3软件进行Meta分析。通过评估统计模型(固定效应模型或随机效应模型)、研究文献质量(低质量或高质量)是否会影响结果,进行敏感性分析以评估结果的稳定性;通过漏斗图定性评价纳入文献的发表偏倚。结果共纳入11项研究,涉及1357例患者。报告的神经重症气管切开患者拔管成功率为46.7%~97.5%;9项研究中拔管成功的定义是无再插管,另外2项未说明;所有研究NOS评分为6~8分,均为高质量研究。Meta分析显示,神经重症气管切开患者的意识水平〔格拉斯哥昏迷评分(GCS)≥8分比<8分:优势比(OR)=3.34,95%可信区间(95%CI)为2.22~5.03,P<0.001〕、气管分泌物量(少比多:OR=13.07,95%CI为5.64~30.32,P<0.001)、咳嗽反射(有比无:OR=14.33,95%CI为6.36~32.28,P<0.001)和吞咽功能(良比差:校正OR=18.56,95%CI为8.16~42.21,P<0.001)与拔管结果的相关性有统计学意义;而肺部感染(无比有:校正OR=1.94,95%CI为0.87~4.35,P=0.11)、血氧饱和度(≥0.95比<0.95:OR=2.34,95%CI为1.11~4.91,P=0.12)、堵管耐受性(良比差:OR=2.12,95%CI为0.67~6.71,P=0.20)及拔管方式(渐进比直接:OR=0.99,95%CI为0.95~1.04,P=0.93)与拔管结果的相关性无统计学意义。敏感性分析显示结果稳定。漏斗图显示,纳入研究对称分布于漏斗两侧,提示存在发表偏倚的可能性较小。结论神经重症气管切开患者有
基金supported by the fund for clinical research project(2015xkj086)
文摘BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.
