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| 压力控制容量保证模式用于老年患者术中机械通气的Meta分析 |
| Pressure-controlled ventilation-volume guaranteed for intraoperative mechanical ventilation in elderly patients: a meta-analysis |
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| DOI：10.12089/jca.2022.07.012 |
| 中文关键词: 压力控制容量保证 老年 机械通气；随机对照试验；Meta分析 |
| 英文关键词: Pressure-controlled ventilation-volume guaranteed Aged Mechanical ventilation Randomized controlled trial Meta-analysis |
| 基金项目:科技部国家重点研发计划-重点专项（2018YFC2001800）；四川大学华西医院临床研究孵化项目（2020HXFH030）；四川大学华西医院临床新技术项目（2018-81） |
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| 中文摘要: |
目的 系统评价压力控制容量保证模式（PCV-VG）用于老年患者术中机械通气的有效性和安全性。
方法 计算机检索PubMed、Web of Science、The Cochrane Library、中国期刊全文数据库（CNKI）、万方和维普数据库，检索PCV-VG用于老年患者术中机械通气的随机对照试验（RCT），检索时限均从建库至2022年1月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.4软件进行Meta分析。
结果 共纳入12篇文献，共计患者749例，PCV-VG组374例，对照组375例。术中机械通气时两组PaO2（MD=5.32 mmHg，95%CI -0.55～11.18，P=0.08）、PaCO2（MD=0.12 mmHg，95%CI -0.18～0.41，P=0.43）差异无统计学意义。与对照组比较，PCV-VG组术中机械通气时气道峰压（Ppeak）明显下降（MD=-3.40 cmH2O，95%CI -4.69～-2.12，P<0.001），肺动态顺应性（Cdyn）明显升高（MD=3.85 ml/cmH2O，95%CI 2.46～5.25，P<0.001）。术中机械通气时两组MAP（MD=-0.22 mmHg，95%CI -1.45～1.01，P=0.72）差异无统计学意义。
结论 PCV-VG用于老年患者术中机械通气时，可以降低老年患者Ppeak、提高Cdyn，但不影响PaO2、PaCO2和MAP。 |
| 英文摘要: |
Objective To systematically evaluate the efficacy and safety of pressure-controlled ventilation-volume guaranteed (PCV-VG) for intraoperative mechanical ventilation in elderly patients.
Methods PubMed, Web of Science, the Cochrane Library,CNKI,Wan Fang and VIP databases were searched to collect randomized controlled trials (RCTs) of PCV-VG for intraoperative mechanical ventilation in aged patients from inception to January 31,2022. Literature screening, data extraction and assessment of the risk bias were undertaken by two authors independently, and then, meta-analysis was performed by using the software Review Manager 5.4.
Results Twelve RCTs were finally included, involving 749 patients, 374 in PCV-VG group and 375 in the control group. There were no significant differences in arterial oxygen pressure (PaO2) (MD = 5.32 mmHg, 95% CI -0.55 to 11.18, P = 0.08), arterial carbon dioxide pressure tension (PaCO2) (MD = 0.12 mmHg, 95% CI -0.18 to 0.41, P = 0.43) between the two groups during intraoperative mechanical ventilation. Compared with the control group, peak airway pressure (Ppeak) was significantly decreased (MD = -3.31 cmH2O, 95% CI -4.53 to -2.09, P < 0.001), and pulmonary dynamic compliance (Cdyn) was significantly improved (MD = 3.85 ml/cmH2O, 95% CI 2.46 to 5.25, P < 0.001) in the PCV-VG group during intraoperative mechanical ventilation. There was no significant differences in the mean arterial pressure (MAP) (MD = -0.22 mmHg, 95% CI -1.45 to 1.01, P = 0.72) between the two groups during intraoperative mechanical ventilation.
Conclusion PCV-VG decreases the Ppeak and improves Cdyn during intraoperative mechanical ventilation in elderly patients without affecting PaO2, PaCO2, and MAP. |
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