密闭式吸痰发生呼吸机相关性肺炎的系统评价_《中国循证医学杂志》

作者：

 靳玲 ¹ , 王海燕 ¹ , 李斌 ²

1. 新疆自治区人民医院急救中心ICU（乌鲁木齐 830001）；2. 新疆自治区人民医院骨一科;

关键词：

密闭式吸痰开放式吸痰呼吸机相关性肺炎随机对照试验系统评价

DOI：

10.7507/1672-2531.20080076

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　比较密闭式吸痰与开放式吸痰在发生呼吸机相关性肺炎等并发症方面的差异。
方法　电子检索Cochrane 图书馆（2007年第1期）、PubMed （1980～2007）、CBM（1980～2007）及CNKI（1980～2007）。手工检索《中华护理杂志》等，收集密闭式吸痰对比开放式吸痰发生呼吸机相关性肺炎等并发症的随机对照试验（RCT），并评价纳入研究的方法学质量。统计分析采用Cochrane协作网提供的RevMan4.2.8软件。
结果　共纳入5个RCT，包括739例患者。Meta分析结果表明，密闭式吸痰与开放式吸痰比较，两组呼吸机相关性肺炎发生率差异无统计学意义［RR=0.83，95%CI（0.50，1.37）］，患者病死率差异无统计学意义［RR=1.05，95%CI（0.85，1.31）］。两种疗法形成总菌落数［RR=1.43，95%CI（0.80，2.53）］、SPP菌落数（不动杆菌属）［RR=2.87，95%CI（0.94，8.74）］和PSE菌落数（铜绿假单胞菌）［RR=1.46，95%CI（0.76，2.77）］差异均无统计学意义。两组患者机械通气及ICU住院时间差异也无统计学意义（P=0.06；P=0.55）。
结论　密闭式吸痰与开放式吸痰比较，两组发生呼吸机相关性肺炎、病死率、总菌落数、SPP和PSE菌落数量、机械通气及ICU住院时间均无差异。因本系统评价存在统计学效能的问题和研究中干预措施不尽相同，结论有待进一步确认，我们尚需更多设计严格的大样本随机对照研究以增加证据的强度。

引用本文： 靳玲,王海燕,李斌. 密闭式吸痰发生呼吸机相关性肺炎的系统评价. 中国循证医学杂志, 2008, 08(5): 346-351. doi: 10.7507/1672-2531.20080076 复制

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.	范关荣, 陈宗南, 葛文, 等. 二种吸痰方法的对比研究. 上海生物医学工程杂志, 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.	杨霞, 范学朋. 密闭式吸痰器在呼吸机治疗中的应用与护理. 中华护理杂志, 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.	王晓萍. 传统吸痰法与密闭式吸痰方式的临床比较. 中国实用护理杂志, 2004, 20(4): 41.
17.	尹利华, 王建荣, 张利岩. 密闭式吸痰研究进展. 南方护理学报, 2005, 12(4): 13-15.
18.	张兵, 王颖, 钟秀玲. 密闭式吸痰在机械通气患者中的临床应用. 现代护理杂志, 2006, 12(20): 1878-1879.
19.	刘妍, 何立平. 密闭式吸痰预防呼吸机相关性肺炎的观察效果. 护理研究杂志, 2006, 20(6): 1619-1620.
20.	王兰, 晁彦公, 李黎明, 等. 密闭式吸痰预防VAP的临床观察. 山东医药, 2006, 46(17): 50-51.
21.	康华. 密闭式吸痰管在机械通气病人气道护理中的应用. 现代护理杂志, 2006, 12(5): 471-473.
22.	田永明, 曾利辉, 廖燕. 密闭式吸痰的研究进展. 中华护理杂志, 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. 范关荣, 陈宗南, 葛文, 等. 二种吸痰方法的对比研究. 上海生物医学工程杂志, 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. 杨霞, 范学朋. 密闭式吸痰器在呼吸机治疗中的应用与护理. 中华护理杂志, 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. 王晓萍. 传统吸痰法与密闭式吸痰方式的临床比较. 中国实用护理杂志, 2004, 20(4): 41.
17. 尹利华, 王建荣, 张利岩. 密闭式吸痰研究进展. 南方护理学报, 2005, 12(4): 13-15.
18. 张兵, 王颖, 钟秀玲. 密闭式吸痰在机械通气患者中的临床应用. 现代护理杂志, 2006, 12(20): 1878-1879.
19. 刘妍, 何立平. 密闭式吸痰预防呼吸机相关性肺炎的观察效果. 护理研究杂志, 2006, 20(6): 1619-1620.
20. 王兰, 晁彦公, 李黎明, 等. 密闭式吸痰预防VAP的临床观察. 山东医药, 2006, 46(17): 50-51.
21. 康华. 密闭式吸痰管在机械通气病人气道护理中的应用. 现代护理杂志, 2006, 12(5): 471-473.
22. 田永明, 曾利辉, 廖燕. 密闭式吸痰的研究进展. 中华护理杂志, 2006, 41(11): 1037-1039.

《中国循证医学杂志》

密闭式吸痰发生呼吸机相关性肺炎的系统评价

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国循证医学杂志》

密闭式吸痰发生呼吸机相关性肺炎的系统评价

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料