持續側方旋轉治療預防呼吸機相關性肺炎的薈萃分析_《中國呼吸與危重監護雜志》

作者：

許旭春 ¹ , 章仲恒 ²

1 金華市中心醫院急診科( 浙江金華 321000) ;;
2 金華市中心醫院危重病醫學科( 浙江金華 321000)通訊作者: 章仲恒, E-mail: zh_zhang1984@ hotmail. com;

關鍵詞：

持續側方旋轉治療呼吸機相關性肺炎薈萃分析

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目的用薈萃分析的方法探討持續側方旋轉治療( CLRT) 預防呼吸機相關性肺炎( VAP) 的效果。方法主要檢索Medline 及中國生物醫學文獻服務系統兩個數據庫, 納入隨機對照
臨床研究, 其中干預組予以CLRT 治療, 對照組予以傳統治療。從每項研究中提取相關數據, 包括研究人群、納入與排除標準、VAP 診斷標準、VAP 發生率、ICU病死率、機械通氣時間和ICU 住院時間。VAP 發生率及病死率作為二分類變量提取, 機械通氣時間和ICU住院時間作為連續變量提取。用ReviewManager 5. 0 系統分析VAP的發生率、病死率及其95% CI, 臨床異質性采用I2 統計量檢驗。結果共有5 項研究符合納入標準。CLRT 治療能顯著降低VAP 發生率( OR = 0. 50, 95% CI 0. 32 ～0. 78) , 且臨床異質性檢驗無顯著性。CLRT 治療不能減少患者ICU 病死率, 對機械通氣時間和ICU住院時間也無顯著影響。結論目前的研究支持CLRT 治療能顯著降低VAP 的發生率, 但對于ICU
病死率、機械通氣時間和ICU住院時間的影響需更多的研究加以探討

引用本文： 許旭春,章仲恒. 持續側方旋轉治療預防呼吸機相關性肺炎的薈萃分析. 中國呼吸與危重監護雜志, 2010, 9(6): 570-574. doi: 復制

1.	Kohlenberg A, Schwab F, Behnke M, et al. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med, 2010, 36: 971-978 .
2.	National Nosocomial Infections Surveillance ( NNIS ) . System Report, data summary from January 1992 through June 2004 , issued October 2004. Am J Infect Control, 2004, 32: 470 -485.
3.	Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care, 2001, 5 : 81-87.
4.	Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
5.	Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest, 1999, 115 : 1658-1666.
6.	Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther,2008, 88: 156-175 .
7.	Traver GA, Tyler ML, Hudson LD, et al. Continuous oscillation:outcome in critically ill patients. J Crit Care, 1995, 10: 97-103.
8.	Whiteman K, Nachtmann L, Kramer D, et al. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care, 1995, 4: 133-139.
9.	MacIntyre NR, Helms M, Wuoderink R, et al. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care, 1999, 44: 1447-1451.
10.	Kirschenbaum L, Azzi E, Sfeir T, et al. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-termventilatory care. Crit Care Med, 2002, 30: 1983-1986.
11.	Wang JY, Chuang PY, Lin CJ, et al. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc,2003, 102 : 788-792.
12.	Ahrens T, Kollef M, Stewart J, et al. Effect of kinetic therapy on pulmonary complications. Am J Crit Care, 2004, 13 : 376-383.
13.	Staudinger T, Bojic A, Holzinger U, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med,2010, 38: 486-490.
14.	張兵, 信如梅, 鐘秀玲. 體位對呼吸機相關性肺炎的影響. 現代護理, 2006 , 12: 1402-1403.
15.	梅小麗, 喻文亮. 呼吸機相關性肺炎防治循證醫學指南. 實用兒科臨床雜志, 2008 , 23: 479-480.
16.	Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
17.	Berra L, Cressoni M, Li Bassi G, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia: the neglected effects of gravity on pathogenesis of ventilator-associated pneumonia. Crit Care Med, 2010 , 38: 1018-1019.
18.	Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
19.	Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
20.	Swadener-Culpepper L, Skaggs RL, VanGilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q,2008,31: 270-279.

1. Kohlenberg A, Schwab F, Behnke M, et al. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med, 2010, 36: 971-978 .
2. National Nosocomial Infections Surveillance ( NNIS ) . System Report, data summary from January 1992 through June 2004 , issued October 2004. Am J Infect Control, 2004, 32: 470 -485.
3. Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care, 2001, 5 : 81-87.
4. Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
5. Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest, 1999, 115 : 1658-1666.
6. Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther,2008, 88: 156-175 .
7. Traver GA, Tyler ML, Hudson LD, et al. Continuous oscillation:outcome in critically ill patients. J Crit Care, 1995, 10: 97-103.
8. Whiteman K, Nachtmann L, Kramer D, et al. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care, 1995, 4: 133-139.
9. MacIntyre NR, Helms M, Wuoderink R, et al. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care, 1999, 44: 1447-1451.
10. Kirschenbaum L, Azzi E, Sfeir T, et al. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-termventilatory care. Crit Care Med, 2002, 30: 1983-1986.
11. Wang JY, Chuang PY, Lin CJ, et al. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc,2003, 102 : 788-792.
12. Ahrens T, Kollef M, Stewart J, et al. Effect of kinetic therapy on pulmonary complications. Am J Crit Care, 2004, 13 : 376-383.
13. Staudinger T, Bojic A, Holzinger U, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med,2010, 38: 486-490.
14. 張兵, 信如梅, 鐘秀玲. 體位對呼吸機相關性肺炎的影響. 現代護理, 2006 , 12: 1402-1403.
15. 梅小麗, 喻文亮. 呼吸機相關性肺炎防治循證醫學指南. 實用兒科臨床雜志, 2008 , 23: 479-480.
16. Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
17. Berra L, Cressoni M, Li Bassi G, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia: the neglected effects of gravity on pathogenesis of ventilator-associated pneumonia. Crit Care Med, 2010 , 38: 1018-1019.
18. Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
19. Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
20. Swadener-Culpepper L, Skaggs RL, VanGilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q,2008,31: 270-279.

《中國呼吸與危重監護雜志》

持續側方旋轉治療預防呼吸機相關性肺炎的薈萃分析

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《中國呼吸與危重監護雜志》

持續側方旋轉治療預防呼吸機相關性肺炎的薈萃分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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