盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜对老年重症肺炎疗效的Meta分析

Meta-analysis of the efficacy of ambroxol hydrochloride combined with expectorator and large dose ambroxol hydrochloride combined with bronchoscopy in elderly patients with severe pneumonia

摘要:

目的 比较正常剂量盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜在治疗老年重症肺炎中的临床疗效。方法 通过计算机检索PubMed、The Cochrane Library、Web of Science、CNKI、万方数据库、维普数据库和中国生物医学文献服务系统，搜索国内外公开发表的有关盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜治疗老年重症肺炎的相关文章，检索时限从建库起到2019年5月。分别由两名作者根据文献纳入和排除标准对文献进行筛选以及数据提取，使用RevMan 5.3软件进行Meta分析。结果 经筛选后共有27篇文献最终被纳入分析。Meta分析结果表明，大剂量盐酸氨溴索联合支气管镜治疗能减少患者ICU住院时间（MD = -1.84，95%CI：-2.21～-1.48）、呼吸机使用时间（MD = -3.93，95%CI：-4.17～-3.69）、治疗期间死亡率（O = 0.42，95%CI：0.33～0.53）、急性生理学与慢性健康状况（APACHE Ⅱ）评分（MD = -0.67，95%CI：-1.05～-0.29）、多器官功能衰竭（MOF）发生率（O = 0.41，95%CI：0.32～0.53）、C反应蛋白（CRP）浓度（MD = -10.35，95%CI：-11.29～-9.41）以及血清降钙素原（PCT）浓度（MD = -0.37，95%CI：-0.40～-0.33），增加患者动脉血氧分压（PaO₂）（MD = 4.85，95%CI：3.83～5.86）、经皮动脉血氧饱和度（SpO₂）（MD = 6.47，95%CI：5.65～7.29）和氧合指数（OI）（PaO₂/FiO₂）（MD = 31.88，95%CI：29.21～34.54）。结论 大剂量使用盐酸氨溴索联合支气管镜治疗老年重症肺炎是安全可行的，且与常规治疗方法相比，在所测指标中均具有一定的优势，有望成为治疗老年重症肺炎的优先选择。

Abstract:

Objective To compare the clinical efficacy of normal dose ambroxol hydrochloride combined with expectorator and large dose ambroxol hydrochloride combined with bronchoscopy in the treatment of senile severe pneumonia.Methods PubMed, the Cochrane Library, Web of Science, CNKI, Wanfang database, Weipu database and China Biomedical Literature Service System were used to search the relevant articles. The articles were retrieved from the database until May 2019. Two authors screened the documents and extracted the data according to the inclusion and exclusion criteria team. Meta-analysis was carried out using RevMan 5.3 software.Results 27 articles were finally included in the analysis after literature screening. Meta-analysis showed that high-dose ambroxol hydrochloride combined with bronchoscopy could significantly reduce ICU hospitalization time (MD = 1.84, 95%CI: -2.21～-1.48), ventilator use time (MD = 3.93, 95%CI: -4.17～-3.69), mortality (O = 0.42, 95%CI: 0.33～0.53), APACHE Ⅱ score (MD = -0.67, 95%CI: -1.05～-0.29), incidence of multiple organ failure (MOF) (O = 0.41, 95%CI: 0.32～0.53), C-reactive protein (CRP) concentration (MD =-10.35, 95%CI: -11.29～-9.41), blood procalcitonin (PCT) concentration (MD = -0.37, 95%CI: -0.40～-0.33), while improve the arterial partial pressure of oxygen (PaO₂) (MD = 4.85, 95%CI: 3.83～5.86), percutaneous arterial oxygen saturation (SpO₂) (MD = 6.47, 95%CI: 5.65～7.29), oxygenation index (OI) (PaO₂/FiO₂) (MD = 31.88, 95%CI: 29.21～34.54).Conclusion Compared with conventional treatment methods, high dose ambroxol hydrochloride combined with bronchoscopy is safe and feasible for the treatment of severe pneumonia in the elderly. The new method has certain advantages in the measured indicators, and it is expected to become a preferred choice for the treatment of severe pneumonia in the elderly.