摘要
目的系统性评价纤维支气管镜(以下简称“纤支镜”)灌洗与普通吸痰管常规吸痰治疗老年吸入性肺炎(AP)的疗效。方法应用计算机检索万方数据库、中国知网(CKNI)、维普数据库(VIP)、PubMed收集国内外关于纤支镜灌洗和常规吸痰管吸痰治疗老年吸入性肺炎的随机对照试验(RCTs),检索时间为自建库至2020年5月。由两名研究者独立筛选文献、评价纳入研究偏倚及提取文献信息,并采用RevMan5.3软件进行Meta分析。结果最终纳入10个RCT研究共814例患者;Meta分析结果提示:纤支镜灌洗较常规吸痰在治疗老年吸入性肺炎效果会更优(RR=1.34,95%CI:1.24~1.44,P<0.00001),纤支镜灌洗后白细胞计数更低(MD=-3.03×109/L,95%CI:-3.76^-2.30,P<0.00001),动脉血氧分压(PaO2)可提高更多(MD=11.72 mmHg,95%CI:4.00~19.43,P<0.005),体温恢复正常时间(MD=-1.18 d,95%CI:-1.47^-0.89,P<0.00001)、咳嗽消失时间(MD=-2.72 d,95%CI:-3.31^-2.12,P<0.00001)、影像学肺部病灶吸收时间(MD=-2.94 d,95%CI:-3.73^-2.15,P<0.00001)和住院天数(MD=-3.43 d,95%CI:-4.22^-2.63,P<0.00001)均短于常规吸痰组,且不良反应易缓解,安全性高。结论与常规吸痰比较,纤维支气管镜灌洗对老年吸入性肺炎有更好的治疗效果,建议应尽早采取纤支镜下肺泡灌洗,以改善患者预后,缩短住院时间,降低插管率和死亡率。
Objective To systematically evaluate the efficacy of fiberoptic bronchoscope lavage and conventional sputum suction in the treatment of in elderly patients with aspiration pneumonia(AP).Methods We searched Wanfang data,CKNI,VIP database,and PubMed to collect randomized controlled trials about bronchofiberscope lavage and conventional sputum suction in the treatment of AP from inception to May 2020.Meta-analysis was performed using RevMan 5.3 software after two investigators independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Results A total of 10 RCT studies were included(including 814 patients).Meta-analysis showed that,compared with conventional sputum aspiration,bronchofiberscope lavage resulted in higher efficacy(RR=1.34,95%CI[1.24-1.44],P<0.00001),lower WBC(MD=-3.03×109/L,95%CI[-3.76 to-2.30],P<0.00001),increased arterial partial pressure of oxygen(PaO2)(MD=11.72 mmHg,95%CI[4.00-19.43],P<0.005),shortened time for body temperature to return to normal(MD=-1.18d,95%CI[-1.47 to-0.89],P<0.00001),shortened time for cough to disappear(MD=-2.72d,95%CI[-3.31 to-2.12],P<0.00001),shortened absorption time for imaging pulmonary lesions(MD=-2.94 d,95%CI[-3.73 to-2.15],P<0.00001),and less days of hospitalization(MD=-3.43 d,95%CI[-4.22 to-2.63],P<0.00001).Moreover,the adverse reactions were easy to be relieved and the safety was high.Conclusion Compared with conventional sputum aspiration,fiberoptic bronchoscopic lavage is more effective in the treatment of AP in the elderly.It is strongly suggested that fiberoptic bronchoalveolar lavage should be taken as soon as possible to improve the prognosis,shorten the length of hospital stay,and reduce the intubation rate and mortality.
作者
王静
蔡秋燕
曾桂星
刘升明
WANG Jing;CAI Qiu-yan;ZENG Gui-xing;LIU Sheng-ming(Department of Respiratory and Critical Care,the First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第21期2826-2831,共6页
Hainan Medical Journal
关键词
纤维支气管镜
灌洗
常规吸痰
吸入性肺炎
系统评价
Fiberoptic bronchoscope
Lavage
Routine sputum aspiration
Aspiration pneumonia
Systematic review
