以质量求发展，以服务铸品牌

护理学报 ›› 2018, Vol. 25 ›› Issue (20): 18-23.doi: 10.16460/j.issn1008-9969.2018.20.018

• 循证护理 • 上一篇    下一篇

院前与入院后气管插管对重型颅脑损伤患者 预后影响的Meta分析

冷志兵1,2, 杨晓玲1, 杨平2, 汪晓媛2, 谢建雷1,2, 蒲亨萍2   

  1. 1.遵义医学院,贵州 遵义 563000;
    2.遵义医学院第三附属医院（遵义市第一人民医院）,贵州 遵义 563002
  • 收稿日期:2018-05-14 发布日期:2020-07-06
  • 通讯作者: 蒲亨萍（1958-）,女,贵州遵义人,本科学历,主任护师。E-mail: pu_hp1958@163.com
  • 作者简介:冷志兵（1992-）,男,贵州遵义人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    遵义市科技局基金项目（遵市科合社字（2017）43号）

Meta-analysis of Different Effects of Pre-hospital and Hospital Endotracheal Intubation on Prognosis of Patients with Severe Traumatic Brain Injury

LENG Zhi-bing1,2, YANG Xiao-ling1, YANG Ping2, WANG Xiao-yuan2, XIE Jian-lei1,2, PU Heng-ping2   

  1. 1. Zunyi Medical Collage, Zunyi 563000, China;
    2. The Third Affiliated Hospital of Zunyi Medical Collage, The First People's Hospital of Zunyi, Zunyi 563002, China
  • Received:2018-05-14 Published:2020-07-06

PDF (PC)

165

赞

摘要： 目的 评价院前急救中气管插管与入院后插管对重型颅脑损伤患者预后的影响。方法 计算机检索PubMed、EMbase、The Cochrane Library、Ovid、CNKI、CBM、万方和维普数据库中有关院前急救中气管插管对重型颅脑损伤患者预后影响的研究,追溯纳入文献和相关综述的参考文献,检索时限均由建库至2017年12月。由2位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析,使用STATA 12.0软件进行敏感性分析,绘制漏斗图分析纳入文献的发表偏倚。结果 最终纳入8篇文献,共17 604例患者。Meta分析结果显示：与入院后气管插管组相比,对重型颅脑损伤患者院前急救进行气管插管后,增加患者的病死率[RR=1.15,95%CI（1.09~1.20）,P<0.00001]及ICU住院时间[SMD=0.56,95%CI（0.12~1.00）,P=0.01];其次,对肺炎发生率[RR=1.28,95%CI（0.95~1.71）,P=0.10]及机械通气时间[SMD=0.15,95%CI（-0.08~0.37）,P=0.20]差异无统计学意义。敏感性分析显示结果较为稳健,发表偏倚检测显示无明显发表偏倚。结论 院前急救中对重型颅脑损伤患者行气管插管可能增加患者病死率,延长ICU住院时间,但对患者入院后肺炎发生率和机械通气时间无显著影响。受纳入研究质量和数量的限制,上述结论有待更多高质量的研究验证。

关键词: 颅脑损伤, 气管插管, 院前急救, 预后, Meta分析

Abstract: Objective To evaluate of the different effects of pre-hospital endotracheal intubation and hospital intubation on the prognosis of patients with severe traumatic brain injury. Methods Literatures of the effect of pre-hospital endotracheal intubation on the prognosis of patients with severe traumatic brain injury were collected from PubMed, EMbase, Ovid, Cochrane Library, CNKI, CBM, Wanfang Data and VIP database from the inception till December 2017 and the references of related literatures were collected as well. Two researchers screened publications independently and methodology quality of the included references was evaluated. Meta-analysis was performed by using RevMan 5.3 software and Stata 12.0 software was used for sensitivity analysis and funnel chart was created for the publication bias of the literatures. Results Eight studies involving 17,604 patients were finally included. The results of meta-analysis showed that the mortality[RR=1.15,95%CI(1.09~1.20), P<0.00001] and ICU length of stay[SMD=0.56,95%CI (0.12~1.00),P=0.01] of patients with severe traumatic brain injury were increased after pre-hospital tracheal intubation when compared with those after hospital intubation, but pre-hospital tracheal intubation exerted no effect on the incidence of pneumonia[RR=1.28,95%CI(0.95~1.71),P=0.10] and duration of mechanical ventilation [SMD=0.15,95%CI(-0.08~0.37),P=0.20]. Sensitivity analysis showed that the results were stable, and no obvious bias was found in the test of publication bias. Conclusion Pre-hospital endotracheal intubation in patients with severe traumatic brain injury may increase the mortality and prolong the duration of ICU length of stay, but has no significant effect on the incidence of pneumonia and the duration of mechanical ventilation. However, more quality RCTs are needed to confirm the conclusion .

Key words: traumatic brain injury, endotracheal intubation, pre-hospital emergency care, the prognosis, Meta-analysis

中图分类号: 

  • R248.2
[1] McMillan T M, Teasdale G M, Stewart E.Disability in Young People and Adults after Head Injury:12-14 Year Follow-up of A Prospective Cohort[J]. J Neurol Neurosurg Psychiatry,2012,83(11):1086-1091. DOI:10.1136/jnnp-2012-302746.
[2] Tuominen R,Joelsson P,Tenovuo O.Treatment Costs and Productivity Losses Caused by Traumatic Brain Injuries[J].Brain Inj,2012, 26(13-14):1697-1701.DOI:10.3109/02699052.2012.722256.
[3] Bratton S L, Chestnut R M, Ghajar J, et al. I. Blood Pressure and Oxygenation[J]. J Neurotrauma, 2007, 24 Suppl 1(supplement 1):7-13.
[4] 夏莹,关柏秋,王翠丽,等.全程优化护理在颅脑损伤患者急救中的应用价值[J].中国医药导报, 2013, 10(26):140-142. DOI:10.3969/j.issn.1673-7210.
[5] 钟鸿波,柳德元,张开权.院前急救早期气管插管对重症颅脑损伤患者的应用效果分析[J]. 中国临床研究, 2014,27(11):1362-1364. DOI:10.13429/j.cnki.cjcr.2014.11.021.
[6] Kurtovic S, Bukur M, Berry C, et al.Pre-hospital Endotracheal Intubation Is Associated with Increased Mortality in Isolated Moderate to Severe Traumatic Brain Injury[J]. J Surg Res, 2011, 165(2):182-182.DOI:10.1016/j.jss.2011.04.005.
[7] National Guideline Clearinghouse (NGC). Guideline Summary: Head Injury. Triage, Assessment, Investigation and Early Management of Head Injury in Children, Young People and Adults. In: National Guideline Clearinghouse (NGC) [EB/OL]. (2014-01-01). Available:https://www.guideline.gov.
[8] Bossers S M, Schwarte L A, Loer S A, et al.Experience in Prehospital Endotracheal Intubation Significantly Influences Mortality of Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis[J]. Plos One, 2015, 10(10):e0141034. DOI:10.1371/journal.pone.0141034.
[9] Bernard S A, Nguyen V, Cameron P, et al.Prehospital Rapid Sequence Intubation Improves Functional Outcome for Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial[J]. Ann Surg, 2010, 252(6):959-965. DOI: 10.1097/SLA.0b013e3181efc15f.
[10] Bochicchio G V, Ilahi O, Joshi M, et al.Endotracheal Intubation in the Field Does Not Improve Outcome in Trauma Patients who Present without An Acutely Lethal Traumatic Brain Injury[J]. J Trauma 2003,54(2):307-311. DOI:10.1097/01.TA.0000109686.44485.14.
[11] Haltmeier T, Benjamin E, Siboni S, et al.Prehospital Intubation for Isolated Severe Blunt Traumatic Brain Injury: Worse Outcomes and Higher Mortality[J]. Eur J Trauma Emerg Surg, 2015, 221(4):1-9. DOI:10.1007/s00068-016-0718-x.
[12] Karamanos E, Talving P, Skiada D, et al.Is Prehospital Endotracheal Intubation associated with Improved Outcomes in Isolated Severe Head Injury? A Matched Cohort Analysis[J]. Prehosp Disaster Med, 2014,29(1):32-36.DOI:10.1017/S1049023X13008947.
[13] Klemen P, Grmec S.Effect of Pre-hospital Advanced Life Support with Rapid Sequence Intubation on Outcome of Severe Traumatic Brain Injury[J]. Acta Anaesthesiol Scand, 2006, 50(10):1250-1254. DOI:10.1111/j.1399-6576.2006.01039.x.
[14] Lansom J D, Curtis K, Goldsmith H, et al.The Effect of Prehospital Intubation on Treatment Times in Patients with Suspected Traumatic Brain Injury[J]. Air Med J, 2016, 35(5):295-300. DOI:10.1016/j.amj.2016.04.019.
[15] Tuma M, El-Menyar A, Abdelrahman H, et al.Prehospital Intubation in Patients with Isolated Severe Traumatic Brain Injury: A 4-Year Observational Study[J]. Crit Care Res Pract, 2014, 2014:135986. DOI:10.1155/2014/135986.
[16] 石齐芳,梁大胜,曾德福,等.单纯重型创伤性颅脑损伤患者院前与院内气管插管的对比研究[J]. 实用医学杂志,2015,31(21):3530-3533.DOI:10.3969/j.issn.1006-5725.
[17] 秦怀海,李润英,刘智,等.气管插管或气管切开术后并发急性气道阻塞的处置[J].中国现代医学杂志,2009,19(22):3510-3511. DOI:10.3969/j.issn.1005-8982.2009.22.043.
[18] 陈锐,阳小生,邹钦,等.院前早期气管插管对中重型颅脑损伤患者病死率的影响[J].山东医药, 2014(18):73-74.DOI:10.3969 /j.issn.1002-266X.2014.18.029.
[19] Von E E, Phenzi S.Pre-hospital Tracheal Intubation in Patients with Traumatic Brain Injury: Systematic Review of Current Evidence[J]. Br J Anaesth, 2009, 103(3):371. DOI:10.1093/bja/aep202.
[20] Franschman G, Peerdeman S M, Greuters S, et al.Prehospital Endotracheal Intubation in Patients with Severe Traumatic Brain Injury: Guidelines Versus Reality[J]. Resuscitation, 2009, 80(10):1147-1151. DOI:10.1016/j.resuscitation.2009.10.028.
[21] Boer C, Franschman G, Loer S A.Prehospital Management of Severe Traumatic Brain Injury: Concepts and Ongoing Controversies[J]. Curr Opin Anaesthesiol, 2012,25(5):556-562. DOI:10.1097/ACO.0b013e328357225c.
[22] 龙贵华,廖彧,巫建芳.院前与院内气管插管在急性重型颅脑损伤患者中的对比研究[J].中国当代医药,2018,25(6):43-45+49.
[23] Fakhry S M, Scanlon J M, Robinson L, et al.Prehospital Rapid Sequence Intubation for Head Trauma: Conditions for A Successful Program[J]. J Trauma, 2006, 60(5):997-1001. DOI:10.1097/01.ta.0000217285.94057.5e.
[24] Yeh D D, George C. Velmahos M D.Prehospital Intubation for Traumatic Brain Injury:Do it Correctly, or Not at All[J]. ANZ J Surg, 2012, 82(7-8):484-485. DOI:10.1111/j.1445-2197.2012.06130.x.
[1] 徐慧民,姚惠娟,傅洁,陶静娟,陆群英,濮建峰,吴品飞,郑纪虎,宛传丹. 全麻手术气管插管患者应用活性银离子抗菌液口咽部处理的效果观察[J]. 护理学报, 2018, 25(7): 60-63.
[2] 杜兰玉, 胡霞, 王向弘, 刘海娜, 任磊, 朱晓秀, 段幼萍. 380例维持性血液透析患者衰弱现状及其对预后的影响[J]. 护理学报, 2018, 25(20): 37-41.
[3] 刘瑞红,朱松,万晶晶,刘映红. 加温输液对预防产妇剖宫产术后低体温和寒颤有效性的Meta分析[J]. 护理学报, 2018, 25(2): 41-47.
[4] 熊璨,高兴莲,向御婷,赵诗雨. 成人手术患者术中低体温影响因素的Meta分析[J]. 护理学报, 2018, 25(2): 48-53.
[5] 周筱春,赵凯怡,李霞,刘一苇,朱聪,陈翔. 认知行为干预对重型颅脑损伤患儿照顾者照顾负担及应对方式的影响[J]. 护理学报, 2018, 25(17): 50-54.
[6] 谢果红,郑赞,吕媛,查文婷,刘桃成. 孕前体质量指数与后代先天性心脏病关联剂量反应关系的Meta分析[J]. 护理学报, 2018, 25(15): 30-36.
[7] 曾星,任秀亚,姜霞,何倩,孙琳. 插入式腹部按压心肺复苏与标准心肺复苏对心脏骤停患者复苏效果和安全性的Meta分析[J]. 护理学报, 2018, 25(14): 37-43.
[8] 曾丽华,张爱霞,朱珠,陈琴,叶敏,刘晓,王义婷. 会阴按摩对产时会阴损伤影响的Meta分析[J]. 护理学报, 2018, 25(13): 46-51.
[9] 范军臣,张会敏,张苗,门华琳,郭茜茜,李鹏阳,孔凡美,王文锐,王玉玲. 艾灸治疗膝骨关节炎的累积Meta分析与试验序贯分析[J]. 护理学报, 2018, 25(11): 35-43.
[10] 张莉,章江琳,虎洁??张彩云,张志刚,魏丽,孙文丽,田金徽. 运动疗法对超重或肥胖孕妇孕期并发症和妊娠结局影响的Meta分析[J]. 护理学报, 2018, 25(11): 44-50.
[11] 曾姗姗,占玮,颜文贞. 大学生院前急救培训方式的研究进展[J]. 护理学报, 2018, 25(10): 32-35.
[12] 孙福月,杨宁,李超,麻苗. 镇静镇痛集束护理对ICU气管插管患者谵妄的影响[J]. 护理学报, 2018, 25(10): 58-61.
[13] 韩燕,王清馨,罗丹,薛俊林. 八段锦对稳定期慢性阻塞性肺疾病患者肺康复影响Meta分析[J]. 护理学报, 2017, 24(9): 15-19.
[14] 但鑫,侯若楠,许素环,刘璟莹,孙福亮,刘彦慧,马宏文. 持续气道正压通气对低氧血症老年患者腹部术后肺部并发症影响的Meta分析和试验序贯分析[J]. 护理学报, 2017, 24(22): 32-38.
[15] 曹娟,李方,周元,袁慧. 适时挤压胸管对胸腔镜肺部手术患者术后的影响[J]. 护理学报, 2017, 24(22): 58-60.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!