Huang Xu An, Du Yan Ping, Fu Bin Bin, Li Liu Xia
Medical College of Xiamen University Department of Respiratory Medicine, Zhongshan Hospital Xiamen University, Teaching Hospital of Fujian Medical University Fujian Medical University, Union Hospital, Zhongshan Hospital Xiamen University.
Medicine (Baltimore). 2018 Jul;97(28):e11223. doi: 10.1097/MD.0000000000011223.
The influence of the subglottic secretion drainage (SSD) on the microorganisms of ventilator associated pneumonia (VAP) is still unclear.A meta-analysis focusing on the influence of the SSD on the microorganisms of VAP.
A comprehensive search was conducted through the online studies of PubMed, Embase, Cochrane Library, Google scholar, CNKI (China National Knowledge Infrastructure), and VIPI (Database for Chinese Technical Periodicals) using specific search terms.Included studies were randomized controlled trials (RCTs) that compare the microorganisms of VAP between SSD and standard endotracheal tube care in mechanically ventilated adults.
Nine RCTs were eligible. There was no significant difference in the rate of VAP caused by nonfermentative bacteria and enterobacteria between SSD group and control group (OR = 0.73, 95%CI, 0.53-1.01; P = .06). The episodes of VAP caused by Gram-positive cocci and Haemophilus influenzae organisms were lower in the SSD group (OR = 0.29, 95%CI, 0.18-0.48; P<0.00001). Less mean volume of SSD daily was observed in VAP group (OR = -16.97, 95%CI, -29.87-4.08; P = .010).
We found SSD to be associated with significant decreases in VAP caused by Gram-positive cocci and H influenzae organisms but no significant differences in VAP caused by nonfermentative bacteria and enterobacteria. Less mean volume of SSD daily was observed in VAP group.
声门下分泌物引流（SSD）对呼吸机相关性肺炎（VAP）微生物的影响尚不清楚。一项荟萃分析聚焦于SSD对VAP微生物的影响。
使用特定检索词，通过PubMed、Embase、Cochrane图书馆、谷歌学术、中国知网（CNKI）和维普中文科技期刊数据库的在线研究进行全面检索。纳入的研究为随机对照试验（RCT），比较机械通气成人中SSD与标准气管插管护理对VAP微生物的影响。
9项RCT符合要求。SSD组与对照组之间由非发酵菌和肠杆菌引起的VAP发生率无显著差异（OR = 0.73，95%CI，0.53 - 1.01；P = 0.06）。SSD组中由革兰氏阳性球菌和流感嗜血杆菌引起的VAP发作较少（OR = 0.29，95%CI，0.18 - 0.48；P < 0.00001）。VAP组每日SSD的平均量较少（OR = -16.97，95%CI，-29.87 - 4.08；P = 0.010）。
我们发现SSD与革兰氏阳性球菌和流感嗜血杆菌引起的VAP显著减少有关，但与非发酵菌和肠杆菌引起的VAP无显著差异。VAP组每日SSD的平均量较少。
