重症肺炎经支气管镜灌洗联合常规治疗的临床疗效的Meta分析

Meta analysis of clinical efficacy of bronchoscopic lavage combined with conventional treatment for severe pneumonia

摘要:

目的 分析常规治疗联合肺泡灌洗对重症肺炎的临床疗效。方法 计算机检索知网、万方、百度学术等国内数据库，以及检索PubMed外文数据库，收集有关重症肺炎常规治疗联合肺泡灌洗的随机对照试验（RCT），检索时限为2019年1月－2021年12月，对照组为重症肺炎常规治疗，实验组为常规治疗联合肺泡灌洗（以下简称联合治疗）。根据Cochrane协作网风险评估手册中对纳入文献的评估方法，2名研究员将纳入的RCT进行质量评价和资料提取。采用RevMan 5.4软件进行Meta分析。结果 共纳入21篇文献，包括1 735例患者，实验组868例，对照组867例。Meta分析结果显示：实验组总有效率高于对照组（OR＾ = 0.16，95%CI：0.13～0.19，P = 0.000）；两组患者发热恢复时间（MD = -3.41，95%CI：-3.67～-3.15，P = 0.000）、肺部啰音消失时间（MD = -2.36，95%CI：-2.70～-2.01，P = 0.000）、咳嗽消失时间（MD = -2.56，95%CI：-2.97～-2.15，P = 0.000）、住院时间（MD = -4.38，95%CI：-5.53～-3.23，P = 0.000）、氧分压（PO₂）（MD = 6.74，95%CI：5.79～7.68，P = 0.000）、二氧化碳分压（PCO₂）（MD = -8.84，95%CI：-11.02～-6.66，P = 0.000）、血氧饱和度（SO₂）（MD = 5.85，95%CI：4.89～6.81，P = 0.000）、降钙素原（PCT）浓度（MD = -1.95，95%CI：-2.96～-0.95，P = 0.000）、C反应蛋白（CRP）浓度（MD = -11.33，95%CI：-19.68～-2.97，P = 0.008）、白细胞（WBC）浓度（MD = -2.69，95%CI：-3.27～-2.11，P = 0.000）和白细胞介素-6（IL-6）浓度（MD = -9.21，95%CI：-11.03～-7.39，P = 0.000）比较，差异均有统计学意义。结论 联合治疗和常规方法治疗重症肺炎，前者整体有效率高于后者，临床症状、住院时间、血气分析和感染指标都有明显改善。但有一些组间Meta分析结果具有高度异质性，结果可靠性仍有待进一步探讨。

Abstract:

Objective To analyze the effect of conventional treatment combined with alveolar lavage in treatment of severe pneumonia.Method Computer retrieval of domestic databases such as CNKI, Wanfang Data, Baidu Scholar, and retrieval of PubMed foreign language database, collect related to severe pneumonia conventional treatment combined with alveolar lavage randomized controlled trials of clinical research, retrieval time limit for January 2019 to December 2021, the control group in the treatment of severe pneumonia conventional, the experimental group for conventional treatment combined with alveolar lavage (hereinafter referred to as the combination therapy). Two researchers evaluated the quality of research methods and extracted data of the included RCTS according to the Cochrane Collaboration Manual of Risk Assessment. RevMan 5.4 software was used for Meta-analysis.Result 21 literatures were included, including 1 735 patients, including 868 in the experimental group and 867 in the control group. The results of Meta-analysis showed: The overall effective rate of the experimental group was higher than that of the control group (OR＾ = 0.16, 95%CI: 0.13～0.19, P = 0.000); Clinical symptoms: recovery time of fever (MD = -3.41, 95%CI: -3.67～-3.15, P = 0.000), crackles disappear time of the lungs (MD = -2.36, 95%CI: -2.70～-2.01, P = 0.000), cough disappearance time (MD = -2.56, 95%CI: -2.97～-2.15, P = 0.000); Length of hospital stay (MD = -4.38, 95%CI: -5.53～-3.23, P = 0.000); Blood gas analysis: partial pressure of oxygen (PO₂) (MD = 6.74, 95%CI: 5.79～7.68, P = 0.000), partial pressure of carbon dioxide (PCO₂) (MD = -8.84, 95%CI: -11.02～-6.66, P = 0.000), blood oxygen saturation (SO₂) (MD = 5.85, 95%CI: 4.89～6.81, P = 0.000); Indicators of infection: PCT concentration (MD = -1.95, 95%CI: -2.96～-0.95, P = 0.000); CRP concentration (MD = -11.33, 95%CI: -19.68～-2.97, P = 0.008); WBC concentration (MD = -2.69, 95%CI: -3.27～-2.11, P = 0.000); IL-6 concentration (MD = -9.21, 95%CI: -11.03～-7.39, P = 0.000). The differences were statistically significant.Conclusion Compared with conventional treatment for severe pneumonia, the overall effective rate of combined treatment is higher than that of conventional treatment. The clinical symptoms, length of hospital stay, blood gas analysis, and infection indicators were greatly improved. However, there are still some inter-group Meta-analysis results with high heterogeneity, and the reliability of the results still need to be further explored.