摘要目的 评价机械通气患者床头抬高不同角度的临床效果.方法 计算机检索中国期刊全文数据(CNKI),中国生物医学文献服务系统(CBM),万方数据库,Cochrane Library,Pubmed,Web of Science中有关机械通气患者床头抬高的随机对照实验,并进行手工检索和引文追踪,检索日期截至2016年6月2日.由2名研究者按照纳入和排除标准筛选文献,对文献质量进行严格评价并提取资料,对符合质量标准的研究使用stata SE12.0软件进行Meta分析.结果 检索获得961条记录,最终纳入17篇文献,其中英文3篇,中文14篇.Meta分析结果显示:与床头抬高小于30度相比,床头抬高30度~45度的转动体位可以显著降低呼吸机相关性肺炎(Ventilator Associated Pneumonia,VAP)的发生率[OR=0.33,95%CI( 0.27,0.41)],缩短机械通气时间[SWD=-3.65,95%CI(-4.90,-2.40)]和ICU住院时间[SWD=-2.95,95%CI(-4.05,-1.85)],并能降低死亡率[OR=0.62,95%CI( 0.44,0.87)].亚组分析结果显示:45度半坐卧位对机械通气患者的临床结局较30度~45度卧位并无显著优势,反而会降低患者的舒适度并增加静脉血栓和压疮的发生率.结论 30度~45度半坐卧位不仅能降低VAP的发生率,还能缩短机械通气时间和ICU住院时间,并能降低死亡率,建议临床推广应用.

abstractsObjective To evaluate the clinical effect of different angle of bed elevation for patients with mechanical ventilation.Methods CNKI,CBM,WanFang Data,Cochrane Library,PubMed,and Web of Science were searched for randomized controlled trials(RCTS) of bed head elevation for patients with mechanical ventilation.The citation tracking and manual retrieval was carried out and the retrieval date was as of June 2,2016.The documents were screened by two reviewers according to the inclusion and exclusion standards.The quality of documents was strictly assessed and the data was extracted, stata SE12.0 software was used for the Meta analysis of the qualified studies.Results 961 records were obtained by searching,and 17 RCTs were included,among which there were 3 English literatures and 14 Chinese literature Meta analysis results showed that compared with a bed elevation of less than 30 degrees,a bed elevation of degree between 30 to 45 degrees can significantly reduce the incidence of ventilator-associated pneumonia (ventilator associated pneumonia,VAP)[OR=0.33,95%CI (0.27,0.41)],and can shorten the duration of mechanical ventilation [SWD=-3.65,95%CI(-4.90,-2.40)]and ICU hospitalization time [SWD=-2.95,95%CI(-4.05,-1.85)]and can reduce the mortality[OR=0.62,95%CI(0.44,0.87)].The sub-analysis results showed that compared with a bed elevation of 30 to 45 degrees,a bed elevation of 45 degrees semireclining position showed no obvious significance in improving patients' clinical outcomes,but can reduce the patients' comfort and increase the incidence of pressure ulcers.Conclusions 30 to 45 degrees semireclining position can not only reduce the incidence of VAP,but also shorten the mechanical ventilation time and ICU length of stay,meanwhile,it can reduce the mortality rate,hence it is recommended to promote clinical application.