A META-ANALYSIS OF THE LITERATURE
A META-ANALYSIS OF THE LITERATURE
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2017
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自充气手动复苏袋（MRB）是物理治疗师常用的一种模式，用于手动过度充气机械通气患者的肺部。支持其治疗用途的科学证据有限，文献对手动过度充盈的影响不一致。对目前的人体研究进行了荟萃分析，以调查这种方式对动脉氧分压和肺顺应性的影响。检索了所有评价手动过度充气（或气囊）对机械通气患者动脉氧分压和/或肺顺应性影响的已发表研究。本分析中仅可使用报告平均值和平均值的标准差或标准误结果的研究。在1968年至1995年期间确定了11项研究。这些研究中有7项符合纳入标准。用动脉血氧分压（Pa 02）和肺顺应性（CL）的平均值和标准差计算95%置信区间，并将结果绘制成图。对7项研究的结果进行了比较分析。证实了装袋与PaO 2/和CL值之间的一般非显著关联。7项纳入研究的设计存在很大差异。由于本荟萃分析中纳入的7项研究显示总体无显著相关性，因此可以合理假设自充气手动复苏袋的治疗价值值得怀疑。这些研究提出了如此不同的设计，以至于它们没有提供决定性的证据。需要更多标准化的多中心研究来阐明这种方式的治疗价值。需要探索在物理治疗干预期间和之后招募危重患者肺的其他方法。
The self-inflating manual resuscitation bag (MRB) is a modality which is commonly used by physiotherapists to manually hyperinflate the lungs o f mechanically ventilated patients. There is limited scientific evidence to support its therapeutic use and the literature is not in agreement as to the effects o f manual hyper inflation. A meta-analysis o f the current research on humans has been conducted to investigate the effects o f this modality on arterial oxygen tensions and lung compliance. All published studies evaluating the effects o f manual hyperinflation (or bagging) on arterial oxygen tensions and/or lung compliance on mechanically ventilated patients have been retrieved. Only studies which reported results in terms o f mean values and standard deviation or standard error o f the mean could be used in this analysis. Eleven studies were identified between the time period 1968 -1995. Seven o f these studies fitted the inclusion criteria. The mean and stan dard error o f the mean values fo r arterial oxygen tensions (Pa02) and lung compliance (CL) have been used to calculate the 95% confidence intervals and these results were plotted on a graph. A comparative analysis has been performed on the results o f the seven studies.'A generally non-significant association between bagging and the Pa02 / and CL values was demonstrated. Great discrepancies were identified in the designs o f the seven included studies. Since the seven studies included in this meta-analysis show an overall non-significant association, it is reasonable to assume that the therapeutic value o f the self-inflating manual resuscitation bag is questionable. The studies presented such divergent designs that they do not offer conclusive evidence. More standardized, multi-centre studies are required to clarify the therapeutic value o f this modality. Other methods o f recruiting the lungs o f critically ill patients during and after physiotherapy intervention, need to be explored.