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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

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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
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