密閉式吸痰發生呼吸機相關性肺炎的系統評價_《中國循證醫學雜志》

作者：

 靳玲 ¹ , 王海燕 ¹ , 李斌 ²

1. 新疆自治區人民醫院急救中心ICU（烏魯木齊 830001）；2. 新疆自治區人民醫院骨一科;

關鍵詞：

密閉式吸痰開放式吸痰呼吸機相關性肺炎隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20080076

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目的　比較密閉式吸痰與開放式吸痰在發生呼吸機相關性肺炎等并發癥方面的差異。
方法　電子檢索Cochrane 圖書館（2007年第1期）、PubMed （1980～2007）、CBM（1980～2007）及CNKI（1980～2007）。手工檢索《中華護理雜志》等，收集密閉式吸痰對比開放式吸痰發生呼吸機相關性肺炎等并發癥的隨機對照試驗（RCT），并評價納入研究的方法學質量。統計分析采用Cochrane協作網提供的RevMan4.2.8軟件。
結果　共納入5個RCT，包括739例患者。Meta分析結果表明，密閉式吸痰與開放式吸痰比較，兩組呼吸機相關性肺炎發生率差異無統計學意義［RR=0.83，95%CI（0.50，1.37）］，患者病死率差異無統計學意義［RR=1.05，95%CI（0.85，1.31）］。兩種療法形成總菌落數［RR=1.43，95%CI（0.80，2.53）］、SPP菌落數（不動桿菌屬）［RR=2.87，95%CI（0.94，8.74）］和PSE菌落數（銅綠假單胞菌）［RR=1.46，95%CI（0.76，2.77）］差異均無統計學意義。兩組患者機械通氣及ICU住院時間差異也無統計學意義（P=0.06；P=0.55）。
結論　密閉式吸痰與開放式吸痰比較，兩組發生呼吸機相關性肺炎、病死率、總菌落數、SPP和PSE菌落數量、機械通氣及ICU住院時間均無差異。因本系統評價存在統計學效能的問題和研究中干預措施不盡相同，結論有待進一步確認，我們尚需更多設計嚴格的大樣本隨機對照研究以增加證據的強度。

引用本文： 靳玲,王海燕,李斌. 密閉式吸痰發生呼吸機相關性肺炎的系統評價. 中國循證醫學雜志, 2008, 08(5): 346-351. doi: 10.7507/1672-2531.20080076 復制

1.	Topeli A, Harmanci A, Cetinkaya Y, et al. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect, 2004, 58(1): 14-19.
2.	范關榮, 陳宗南, 葛文, 等. 二種吸痰方法的對比研究. 上海生物醫學工程雜志, 2004, 25(4): 19-21.
3.	Blackwood B, Webb CH. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect, 1998, 39: 315-321.
4.	楊霞, 范學朋. 密閉式吸痰器在呼吸機治療中的應用與護理. 中華護理雜志, 2005, 40(3): 196-198.
5.	Lorente L, Lecuona M, et al. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med, 2005, 33(1): 115-119.
6.	Stoller JK, Orens DK, Fatica C, et al. Weekly versus daily changes of in line suction cat heters: impact on rates of ventilator associated pneumonia and associated costs. Respir Care, 2003, 48(5): 494-499.
7.	Deppe SA, Kelly JW, Thoi LL, et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med, 1990, 18: 1389-1393.
8.	Adams DH, Hughes M, Elliott TS. Microbial colonization of closed system suction catheters used in liver transplant patients. Intensive Crit Care Nurs, 1997, 13(2): 72-76.
9.	Zeitoun SS, De Barros AL, Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs, 2003, 12(4): 484-489.
10.	Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomized evaluation of the Stericath closed suctioning system. Intensive Care Med, 2000, 26(7): 878-882.
11.	Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator- associated pneumonia, and nursing efficacy. Taehan Kanho Hakhoe Chi, 2004, 34(7): 1315-1325.
12.	Johnson KL, Kearney PA, Johnson SB, et al. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med, 1994, 22: 658-666.
13.	Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol, 2000, 20: 151-156.
14.	Lee CK, Ng KS, Tan SG, et al. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singapore, 2001, 30: 239-244.
15.	Jongerden IP, Rovers MM, Grypdonck MH, et al. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis. Crit Care Med, 2007, 35(1): 260-270.
16.	王曉萍. 傳統吸痰法與密閉式吸痰方式的臨床比較. 中國實用護理雜志, 2004, 20(4): 41.
17.	尹利華, 王建榮, 張利巖. 密閉式吸痰研究進展. 南方護理學報, 2005, 12(4): 13-15.
18.	張兵, 王穎, 鐘秀玲. 密閉式吸痰在機械通氣患者中的臨床應用. 現代護理雜志, 2006, 12(20): 1878-1879.
19.	劉妍, 何立平. 密閉式吸痰預防呼吸機相關性肺炎的觀察效果. 護理研究雜志, 2006, 20(6): 1619-1620.
20.	王蘭, 晁彥公, 李黎明, 等. 密閉式吸痰預防VAP的臨床觀察. 山東醫藥, 2006, 46(17): 50-51.
21.	康華. 密閉式吸痰管在機械通氣病人氣道護理中的應用. 現代護理雜志, 2006, 12(5): 471-473.
22.	田永明, 曾利輝, 廖燕. 密閉式吸痰的研究進展. 中華護理雜志, 2006, 41(11): 1037-1039.

1. Topeli A, Harmanci A, Cetinkaya Y, et al. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect, 2004, 58(1): 14-19.
2. 范關榮, 陳宗南, 葛文, 等. 二種吸痰方法的對比研究. 上海生物醫學工程雜志, 2004, 25(4): 19-21.
3. Blackwood B, Webb CH. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect, 1998, 39: 315-321.
4. 楊霞, 范學朋. 密閉式吸痰器在呼吸機治療中的應用與護理. 中華護理雜志, 2005, 40(3): 196-198.
5. Lorente L, Lecuona M, et al. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med, 2005, 33(1): 115-119.
6. Stoller JK, Orens DK, Fatica C, et al. Weekly versus daily changes of in line suction cat heters: impact on rates of ventilator associated pneumonia and associated costs. Respir Care, 2003, 48(5): 494-499.
7. Deppe SA, Kelly JW, Thoi LL, et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med, 1990, 18: 1389-1393.
8. Adams DH, Hughes M, Elliott TS. Microbial colonization of closed system suction catheters used in liver transplant patients. Intensive Crit Care Nurs, 1997, 13(2): 72-76.
9. Zeitoun SS, De Barros AL, Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs, 2003, 12(4): 484-489.
10. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomized evaluation of the Stericath closed suctioning system. Intensive Care Med, 2000, 26(7): 878-882.
11. Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator- associated pneumonia, and nursing efficacy. Taehan Kanho Hakhoe Chi, 2004, 34(7): 1315-1325.
12. Johnson KL, Kearney PA, Johnson SB, et al. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med, 1994, 22: 658-666.
13. Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol, 2000, 20: 151-156.
14. Lee CK, Ng KS, Tan SG, et al. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singapore, 2001, 30: 239-244.
15. Jongerden IP, Rovers MM, Grypdonck MH, et al. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis. Crit Care Med, 2007, 35(1): 260-270.
16. 王曉萍. 傳統吸痰法與密閉式吸痰方式的臨床比較. 中國實用護理雜志, 2004, 20(4): 41.
17. 尹利華, 王建榮, 張利巖. 密閉式吸痰研究進展. 南方護理學報, 2005, 12(4): 13-15.
18. 張兵, 王穎, 鐘秀玲. 密閉式吸痰在機械通氣患者中的臨床應用. 現代護理雜志, 2006, 12(20): 1878-1879.
19. 劉妍, 何立平. 密閉式吸痰預防呼吸機相關性肺炎的觀察效果. 護理研究雜志, 2006, 20(6): 1619-1620.
20. 王蘭, 晁彥公, 李黎明, 等. 密閉式吸痰預防VAP的臨床觀察. 山東醫藥, 2006, 46(17): 50-51.
21. 康華. 密閉式吸痰管在機械通氣病人氣道護理中的應用. 現代護理雜志, 2006, 12(5): 471-473.
22. 田永明, 曾利輝, 廖燕. 密閉式吸痰的研究進展. 中華護理雜志, 2006, 41(11): 1037-1039.

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密閉式吸痰發生呼吸機相關性肺炎的系統評價

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《中國循證醫學雜志》

密閉式吸痰發生呼吸機相關性肺炎的系統評價

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