支气管镜灌洗术治疗老年重症肺部感染的应用价值：一项Meta分析

The Application Value of Bronchoscopic Lavage in the Treatment of Severe Pulmonary Infection in the Elderly: A Meta-Analysis

摘要: 目的：采用Meta分析评价支气管镜灌洗术治疗老年重症肺部感染的有效性及安全性。方法：通过计算机检索中国知网(CNKI)、维普科技期刊数据库(VIP)、万方医学网、中国生物医学文献数据库(CBM)、PubMed、The Cochrane Library等数据库，搜集时间为自建库至2024年2月期间支气管镜灌洗术用于治疗老年重症肺部感染的随机对照试验(RCT)，由两位研究者根据设定的纳入与排除标准对文献进行筛选，并提取相关资料。为确保研究的客观性和准确性，同时对纳入的研究进行了偏倚风险的评估。最后利用RevMan 5.4和Stata 17.0软件进行了深入的Meta分析。结果：共纳入17篇文献，总计1516位研究对象，其中试验组共758位，对照组共758位，Meta分析结果显示，相较于常规治疗，支气管肺泡灌洗术能更有效地提高治疗有效率[RR = 1.23, 95% CI (1.18, 1.29), P < 0.01]，减短住院时间(MD = −6.85, 95%CI: −7.37, −6.33, P < 0.00001)，退热时间(MD = −4.28, 95%CI: −4.68, −3.89, P < 0.00001)及肺部啰音等症状消失时间(MD = −4.40, 95%CI: −4.79, −4.01, P < 0.00001)，血气分析指标如PaO₂ (MD = 11.81, 95%CI: 11.13, 12.48, P < 0.00001)改善程度较常规组也更明显。此外，17篇文献中，共12篇是关于不良反应的比较，其中实验组心律失常9例、气胸4例、咯血6例、死亡病例0例，分别低于常规治疗组的心律失常10例、气胸13例、咯血12例、死亡病例3例，差异有统计学意义。结论：相较于常规治疗组，支气管肺泡灌洗组整体有效率更高，在住院时间、临床症状、血气分析等方面都有明显优势。但某些指标的Meta分析结果异质性较高，未来仍需更多的高质量、足够样本量的国内外文献进行对比分析来提高其可靠性。

Abstract: Objective: To evaluate the efficacy and safety of bronchoscopic lavage in the treatment of elderly patients with severe pulmonary infection by meta-analysis. How: Through computer retrieval of CNKI, VIP, Wanfang Medical Network, CBM, PubMed, The Cochrane Library and other databases, The randomized controlled trial (RCT) of bronchoscopic lavage for the treatment of severe pulmonary infection in elderly patients was collected from the self-established database to February 2024. Two investigators screened the literature according to the set inclusion and exclusion criteria and extracted relevant data. To ensure objectivity and accuracy, the included studies were assessed for risk of bias. Meta-analysis was performed using RevMan 5.4 and Stata 17.0 software. Result: A total of 17 literatures were included, including a total of 1516 subjects, including 758 subjects in the experimental group and 758 subjects in the control group. The results of meta-analysis showed that bronchoalveolar lavage was more effective in improving the treatment response rate than conventional treatment [RR = 1.23, 95%CI (1.18, 1.29), P < 0.01]. The duration of hospitalization was shortened (MD = −6.85, 95%CI: −7.37, −6.33, P < 0.00001), the duration of fever remission (MD = −4.28, 95%CI: −4.68, −3.89, P < 0.00001), and the duration of pulmonary rales and other symptoms to disappear (MD = −4.40, 95%CI: −4.79, −4.01, P < 0.00001), and the improvement of blood gas analysis indexes such as PaO₂ (MD = 11.81, 95%CI: 11.13, 12.48, P < 0.00001) was more significant than that in the conventional group. In addition, among the 17 literatures, 12 were about the comparison of adverse re-actions, of which 9 cases of arrhythmia, 4 cases of pneumothorax, 6 cases of hemoptysis, and 0 cases of death in the experimental group were lower than 10 cases of arrhythmia, 13 cases of pneumothorax, 12 cases of hemoptysis, and 3 cases of death in the conventional treatment group, respectively, with statistical significance. Conclusion: Compared with the conventional treatment group, the bronchoalveolar lavage group has a higher overall effective rate, and has obvious advantages in hospital stay, clinical symptoms and blood gas analysis. However, the meta-analysis results of some indicators are highly heterogeneous, and more high-quality domestic and foreign literatures with sufficient sample size are still needed for comparative analysis in the future to improve their reliability.