Sun Xiaowen, Zhang Jiale, Jiang Ting, Tang Rui, Chen Xia, Liu Fen, Qian Kejian, Jiang Rong
Department of Critical Care Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China (Sun XW, Zhang JL, Tang R, Chen X, Liu F, Qian KJ, Jiang R); Department of Central Supply Service, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China (Jiang T). Corresponding author: Jiang Rong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Jul;29(7):586-591. doi: 10.3760/cma.j.issn.2095-4352.2017.07.003.
To systematically evaluate the comprehensive effect of subglottic secretion drainage (SSD) on patients with mechanical ventilation (MV) in intensive care unit (ICU).
The randomized controlled clinical trials (RCTs) comparing SSD (intervention group) versus non-SSD (control group) in adult patients with MV in ICU was collected through the databases such as the PubMed database of the National Library of Medicine, CNKI, Wanfang database and the Chinese journal of science and technology database (VIP). The subjects were ICU patients with MV, and the retrieval time ranged from January 2006 to December 2016. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, and assessed the quality. Then RevMan 5.3 software was used for Meta-analysis. Sensitivity analysis was performed using Stata 11.0 software. Funnel plot was used to analyze publication bias.
In the 1 004 documents obtained from preliminary screening, a total of 13 studies involving 2 052 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria, with 1 021 patients in intervention group, and 1 031 in control group. Meta-analysis showed that compared with control group, the application of SSD in patients with MV could contribute to the reduction of the incidence of ventilator-associated pneumonia [VAP; risk ratio (RR) = 0.54, 95% confidence interval (95%CI) = 0.46-0.64, P < 0.000 01], the duration of MV [mean difference (MD) = -3.29, 95%CI = -4.53 to -2.05, P < 0.000 01] and length of hospital stay (MD = -4.27, 95%CI = -7.36 to -1.18, P = 0.007) were shortened, while there was no significant difference in ICU or hospital mortality rate between the intervention group and control group (RR = 0.89, 95%CI = 0.73-1.09, P = 0.25). The sensitivity analysis for studies enrolled in Meta-analysis of MV duration showed that individual research results were stable through step remove of the included literatures and combined calculation of the remaining literature value, suggesting that individual research results were stable, and would not have a significant impact on the overall results. The results of the funnel analysis showed that there was a symmetry in the inclusion studies, and no significant publication bias was found.
SSD did have effect in reducing the incidence of VAP, shortening the duration of MV and length of hospital stay, while there was no significant effect on reducing mortality rate. Effective use of SSD is an important measure to prevent VAP. It is necessary to objectively evaluate the clinical effect of SSD.
系统评价声门下分泌物引流（SSD）对重症监护病房（ICU）中机械通气（MV）患者的综合影响。
通过美国国立医学图书馆的PubMed数据库、中国知网、万方数据库和维普数据库等收集比较ICU中成年MV患者SSD（干预组）与非SSD（对照组）的随机对照临床试验（RCT）。研究对象为ICU中MV患者，检索时间为2006年1月至2016年12月。两名评价员根据纳入和排除标准独立筛选研究、提取数据并评估质量。然后使用RevMan 5.3软件进行Meta分析。使用Stata 11.0软件进行敏感性分析。采用漏斗图分析发表偏倚。
在初步筛选获得的1004篇文献中，排除重复文献和不符合纳入标准的文献后，共纳入13项研究，涉及2052例患者，其中干预组1021例，对照组1031例。Meta分析显示，与对照组相比，MV患者应用SSD可降低呼吸机相关性肺炎（VAP）的发生率[风险比（RR）=0.54，95%置信区间（95%CI）=0.46-0.64，P<0.000 01]，缩短MV持续时间[平均差（MD）=-3.29，95%CI=-4.53至-2.05，P<0.000 01]和住院时间（MD=-4.27，95%CI=-7.36至-1.18，P=0.007），而干预组与对照组在ICU或医院死亡率方面无显著差异（RR=0.89，95%CI=0.73-1.09，P=0.25）。MV持续时间Meta分析纳入研究的敏感性分析显示，通过逐步剔除纳入文献并综合计算剩余文献值，个体研究结果稳定，提示个体研究结果稳定，对总体结果无显著影响。漏斗分析结果显示纳入研究具有对称性，未发现显著的发表偏倚。
SSD在降低VAP发生率、缩短MV持续时间和住院时间方面有作用，而对降低死亡率无显著作用。有效使用SSD是预防VAP的重要措施。有必要客观评估SSD的临床效果。
