【摘要】：目的評(píng)價(jià)早期氣管切開與延遲氣管切開對(duì)重型顱腦損傷患者預(yù)后的影響。方法計(jì)算機(jī)檢索Conchrane Library、PubMed、Embase、OVID、CBM、CNKI、萬方和維普數(shù)據(jù)庫中關(guān)于早期氣管切開對(duì)重型顱腦損傷患者預(yù)后影響的隨機(jī)對(duì)照試驗(yàn)(RCT),檢索時(shí)限由建庫至2016年3月,同時(shí)查閱所獲取的參考文獻(xiàn)索引。兩名研究者對(duì)檢索收集到的文獻(xiàn)按照制訂的納入、排除標(biāo)準(zhǔn)進(jìn)行獨(dú)立篩選。以呼吸機(jī)相關(guān)性肺炎(VAP)發(fā)生率,機(jī)械通氣時(shí)間,ICU住院時(shí)間、病死率作為評(píng)價(jià)指標(biāo)。對(duì)納入文獻(xiàn)進(jìn)行方法學(xué)質(zhì)量評(píng)價(jià),采用Review Manager 5.3軟件進(jìn)行Meta分析。結(jié)果最終納入4篇隨機(jī)對(duì)照研究,共220例患者。Meta分析結(jié)果顯示:早期氣管切開對(duì)顱腦損傷患者的VAP發(fā)病率(P=0.15)及病死率(P=0.20)差異無統(tǒng)計(jì)學(xué)意義,但對(duì)機(jī)械通氣時(shí)間(P=0.01)及ICU住院時(shí)間(P=0.05)差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論早期氣管切開不能降低重型顱腦損傷患者VAP發(fā)病率及病死率,但能減少機(jī)械通氣時(shí)間和ICU住院時(shí)間。
[Abstract]:Objective to evaluate the effect of early tracheotomy and delayed tracheotomy on the prognosis of patients with severe craniocerebral injury. Methods computer search was performed for the Conchrane Library Conchrane Embase (OVIDC) (RCT), the (RCT), retrieval time of the randomized controlled trial (RCT),) about the influence of early tracheotomy on the prognosis of patients with severe craniocerebral injury in Wanfang and Weip databases, and the index of references obtained were also consulted. The two researchers independently screened the collected literature according to the established inclusion and exclusion criteria. The incidence of ventilator-associated pneumonia (VAP), the duration of mechanical ventilation and the length of hospitalization and mortality were used as indicators. The methodological quality of the literature was evaluated and the Meta analysis was carried out with Review Manager 5.3 software. Results four randomized controlled trials were conducted. The results of Meta-analysis showed that there was no significant difference in the incidence of VAP (P0. 15) and mortality (P0. 20) in patients with craniocerebral injury by early tracheotomy. But there were significant differences in mechanical ventilation time (P0. 01) and ICU hospitalization time (P0. 05). Conclusion early tracheotomy can not reduce the incidence and mortality of VAP in patients with severe craniocerebral injury, but it can reduce the time of mechanical ventilation and the hospitalization time of ICU.
【作者單位】： 重慶醫(yī)科大學(xué)附屬永川醫(yī)院重癥醫(yī)學(xué)科;
【基金】：重慶市永川區(qū)科技劃項(xiàng)目(YCSTC2012BE5008)
【分類號(hào)】：R651.15

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