智能脱机模式对机械通气时间影响的系统评价

doi:10.3969/j.issn.1006-7795.2013.02.006

摘要/Abstract

摘要：

目的评价智能脱机模式对机械通气时间、脱机时间、重症监护(intensive care unit,ICU)时间、总住院时间、病死率和不良事件发生率的影响。方法计算机检索PubMed,EMBASE,CINAHL,CENTRAL,SinoMed 和ISI Web of knowledge,手工检索初步入选文献的全文和参考文献中所列的相关文献,收集国内外关于智能脱机模式和人工脱机模式比较的随机对照和半随机对照研究。对纳入的文献进行治疗评价和定量分析。结果共13篇文献入选,合并分析显示智能化脱机模式能够缩短机械通气时间[MD=-63.98,95%CI(-108.67,-19.29)]和脱机时间[MD=0.84,95%CI(-1.31,2.99)],降低再插管[RR 0.75,95%CI(0.57, 0.98)]和机械通气大于14 d患者比例[RR 0.66,95%CI(0.44,0.99)],但对ICU和总住院时间、病死率无显著性影响。结论智能化脱机模式能够缩短机械通气时间和脱机时间,降低不良事件发生率,但因研究间的异质性较强,结果的解释需要谨慎。

关键词: 机械通气, 脱机, 计算机辅助治疗, Meta分析

Abstract:

Objective To investigate the effects of automated weaning mode on the total duration of mechanical ventilation, weaning duration, mortality, length of stay in the intensive care unit and hospital, and adverse events. Methods We searched PubMed, EMBASE, CINAHL, CENTRAL, SinoMed and ISI Web of knowledge, and reference list of articles. We included randomized and quasi-randomized controlled trials comparing automated with non-automated mode in the weaning from mechanical ventilation in critically ill adults. The quality of included studies was critically evaluated and quantitatively analyzed. Results Thirteen trials met the inclusion criteria. Compared with non-automated mode, the duration of mechanical ventilation and weaning in the weaning automated group was reduced significantly [MD=-63.98, 95%CI(-108.67, -19.29)] and [MD=0.84, 95%CI(-1.31, 2.99)], respectively in the mechanical ventilation <24 h subgroup. The re-intubation rate and requirement for protracted weaning over 14 days were significant in the mechanical ventilation <24 h subgroup. Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and adverse events when automated mode are used. As a result of significant heterogeneity among studies, our findings should be interpreted with caution.

Key words: mechanical ventilators, ventilator weaning, computer-assisted therapy, Meta-analysis

中图分类号:

朱波, 李志强, 席修明. 智能脱机模式对机械通气时间影响的系统评价[J]. 首都医科大学学报, 2013, 34(2): 191-200.

ZHU Bo, LI Zhiqiang, XI Xiuming. Automated mode in the weaning of mechanical ventilated patients: a systematic review[J]. Journal of Capital Medical University, 2013, 34(2): 191-200.

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