持续气道正压通气对胸腹部手术患者术后并发症和死亡率影响的Meta分析

The Effect of Continuous Positive Airway Pressure after Thoracic and Abdominal Surgery for Prevention of Postoperative Morbidity and Mortality: A Meta-Analysis

摘要: 目的：系统评价持续气道正压通气对胸腹部手术患者术后并发症及死亡率的影响。方法：计算机检索PubMed、The Cochrane Library、CKNI、VIP和万方数据库，查找有关持续性正压通气对胸腹部手术患者术后并发症和死亡率影响的随机对照试验(RCT)。按照纳入与排除标准，2位评价员独立进行文献筛选、资料提取和偏倚风险评价，采用RevMan5.2软件进行Meta分析。结果：最终纳入8项RCT，共746例患者。分析结果显示：持续气道正压通气组术后病人肺炎发生率3.01%、肺不张发生率10.57%、重度缺氧发生率2.9%、重新置管率0.81%、术后感染率1.88%，均低于常规治疗组，差异具有统计学意义，但平均住院天数9.45，ICU转入率5.58%和全因死亡率1.66%方面无统计学意义。结论：持续气道正压通气对降低肺炎、肺不张、重新置管及术后伤口感染发生率有一定效果，但对降低ICU转入率、住院天数、死亡率的效果还不能确定，受纳入研究数和质量限制，上述结论需展开更多高质量研究予以验证。

Abstract: Objective: To evaluate the effect of continuous positive airway pressure after thoracic and ab-dominal surgery for prevention of postoperative morbidity and mortality. Methods: Randomized controlled trials (RCTs) related to continuous positive airway pressure intervention after abdominal surgery were retrieved from databases such as PubMed, Cochrane library, CNKI, VIP, and Wanfang Database. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, extracted the data and assessed the quality of included studies, and then meta-analysis was performed using Review Manager 5.2. Results: A total of 8 studies involving 746 patients were included. The results of meta-analysis showed that CPAP was significantly superior to usual treatment in decreasing morbidity of pneumonia 3.01%, atelectasis 10.57%, severe hypoxia 2.9%, reintubation 0.81%, and wound infection 1.88%. Compared with standard therapy, there was no significant difference for CPAP in reducing length of hospital stay 9.45, admission to ICU 5.58%, and all cause mortality 1.66%. Conclusion: CPAP therapy significantly reduced incidence of pneumonia, atelectasis, reintubation, and wound infection for postoperative patients, but its effect on reducing length of hospital stay, transfer to ICU, and mortality is unsure.