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胸腔闭式引流与保守治疗作为原发性自发性气胸初始治疗方法的系统评价和Meta分析

Chest Tube Drainage Versus Conservative Management as the Initial Treatment of Primary Spontaneous Pneumothorax: A Systematic Review and Meta-Analysis.

作者信息

Lee Jong Hyuk, Kim Ryul, Park Chang Min

机构信息

Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul 03080, Korea.

Department of Internal Medicine, Seoul National University Hospital, Seoul National College of Medicine, Seoul 03080, Korea.

出版信息

J Clin Med. 2020 Oct 27;9(11):3456. doi: 10.3390/jcm9113456.

Abstract

This systematic review and meta-analysis aimed to compare chest tube drainage and conservative management as the initial treatment of primary spontaneous pneumothorax (PSP). Studies including PSP patients who received tube drainage or conservative management as the initial treatment were searched in OVID-MEDLINE and Embase through 14 February 2020. The primary outcome was the relative risk (RR) of PSP recurrence, and secondary outcomes were RRs of PSP resolution and adverse events during treatment. A random-effect model using the Mantel-Haenszel method was used to pool RRs. Subgroup and meta-regression analyses were performed to investigate significant predictors of PSP recurrence. In total, 11,922 PSP cases from eight studies were analysed, of which 6344 were treated with tube drainage and 5578 were treated with conservative management. The pooled RR of PSP recurrence for conservative management against tube drainage was 0.98 (95% confidence interval [CI], 0.75-1.28; = 0.894). Subgroup and meta-regression analyses revealed that study design ( = 0.816), allocation of the PSP amount in each management group ( = 0.191), and assessment time for recurrence had no significant impact on PSP recurrence ( = 0.816). There was no publication bias ( = 0.475). The risk of adverse events of conservative management was significantly lower than that of tube drainage (pooled RR, 0.22; 95% CI, 0.08-1.15; = 0.003). However, no difference was found between the two groups in terms of PSP resolution (pooled RR, 1.01; 95% CI, 0.9-1.15; = 0.814). As the initial treatment for PSP, conservative management is comparable to chest tube drainage in terms of PSP recurrence and resolution after treatment, with fewer adverse events during treatment.

摘要

本系统评价和荟萃分析旨在比较胸腔闭式引流术与保守治疗作为原发性自发性气胸(PSP)初始治疗方法的效果。通过检索截至2020年2月14日的OVID-MEDLINE和Embase数据库,纳入了将胸腔闭式引流术或保守治疗作为初始治疗方法的PSP患者的研究。主要结局是PSP复发的相对风险(RR),次要结局是PSP缓解的RR以及治疗期间不良事件的RR。采用Mantel-Haenszel方法的随机效应模型来汇总RR。进行亚组分析和Meta回归分析以研究PSP复发的显著预测因素。总共分析了来自8项研究的11922例PSP病例,其中6344例接受了胸腔闭式引流术治疗,5578例接受了保守治疗。保守治疗与胸腔闭式引流术相比,PSP复发的汇总RR为0.98(95%置信区间[CI],0.75-1.28;P=0.894)。亚组分析和Meta回归分析显示,研究设计(P=0.816)、各治疗组中PSP量的分配(P=0.191)以及复发评估时间对PSP复发均无显著影响(P=0.816)。不存在发表偏倚(P=0.475)。保守治疗的不良事件风险显著低于胸腔闭式引流术(汇总RR,0.22;95%CI,0.08-1.15;P=0.003)。然而,两组在PSP缓解方面未发现差异(汇总RR,1.01;95%CI,0.9-1.15;P=0.814)。作为PSP的初始治疗方法,保守治疗在治疗后PSP复发和缓解方面与胸腔闭式引流术相当,且治疗期间不良事件较少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93dc/7693596/56369d5dbe83/jcm-09-03456-g001.jpg

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