文章摘要
不同水平呼气末正压对肥胖患者术中氧合指数影响的Meta分析
Comparison of different level of positive end-expiratory pressure on oxygenation index in obese patients: a meta-analysis
  
DOI：10.12089/jca.2022.05.012
中文关键词: 肥胖  呼气末正压  氧合指数  Meta分析
英文关键词: Obesity  Positive end-expiratory pressure  Oxygenation index  Meta-analysis
基金项目:
作者单位E-mail
蔡雪纯 210029,南京医科大学第一附属医院麻醉科  
周珍辉 210029,南京医科大学第一附属医院麻醉科  
朱伟 210029,南京医科大学第一附属医院麻醉科 zhuweijsph＠163.com 
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中文摘要:
      
目的 评估不同水平呼气末正压（PEEP）对肥胖患者术中氧合指数的影响。
方法 检索PubMed、Embase、Cochrane Library、知网和万方数据库，收集高水平（PEEP≥10 cmH2O）与低水平（PEEP≤5 cmH2O） PEEP对肥胖患者术中氧合指数和术后肺部并发症影响的随机对照试验（RCT），检索时间为建库至2021年5月。主要指标为术中氧合指数，次要指标为术后肺部并发症。根据纳入和排除标准进行文献筛选、数据提取和质量评价，采用RevMan 5.4软件进行Meta分析。
结果 共纳入11篇发表于2004—2020年的RCT研究，共纳入患者2 522例，其中高PEEP组1 209例，低PEEP组1 313例。Meta分析显示，与低PEEP组比较，高PEEP组术中氧合指数明显升高（MD=74.21 mmHg，95%CI 46.98~101.43 mmHg, P<0.001），两组术后肺部并发症发生率差异无统计学意义（RR=0.87， 95%CI 0.74～1.02， P=0.09）。
结论 全麻期间采用PEEP≥10 cmH2O可以改善肥胖患者术中氧合指数，对肺功能具有一定的保护作用，但是不能降低肥胖患者术后肺部并发症的发生率。
英文摘要:
      
Objective To compare the different level of positive end-expiratory pressure on oxygenation indexin obese patients.
Methods PubMed, Embase, Cochrane Library, CNKI and Wanfang data were searched for all randomized controlled trials (RCT) from the year of establishment to May 2021, focusing on comparing high (PEEP ≥ 10 cmH2O) versus low (PEEP ≤ 5 cmH2O) level of positive end-expiratory in obese patients. Main evaluation indicator was oxygenation index, and the secondary evaluation indicator was postoperative pulmonary complications. Reviewers independently identified the literature according to the inclusion and exclusion criteria and conducted data extraction and quality evaluation, and RevMan 5.4 was used to analyze the data.
Results Eleven RCTs published in the period of 2004 to 2020 enrolling 2 522 patients met the inclusion criteria, including 1 209 patients in the experimental group and 1 313 patients in the control group. The
Results of meta-analysis showed that compared with low PEEP group, high PEEP group contributed to higher oxygenation index ratio (MD = 74.21 mmHg, 95% CI 46.98-101.43 mmHg, P < 0.001). However, there was no significant difference in high PEEP group and low PEEP group on postoperative pulmonary complications (RR = 0.87, 95% CI 0.74-1.02, P = 0.09).
Conclusion Intraoperative PEEP ≥ 10 cmH2O can improve oxygenation index in obese patients showing a protective effect on pulmonary function to some extent, but it has no effect on postoperative pulmonary complications.
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