114334围术期吸入高浓度氧减少外科感染的作用一项Meta分析r.docVIP

围手术期高浓度氧气吸入对减少外科感染的作用：一项荟萃分析 Brandon Togioka, MD, Samuel Galvagno, DO, Shawn Sumida, MD, Jamie Murphy, MD,Jean-Pierre Ouanes, DO, and Christopher Wu, MD Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 摘要 背景 目前，高浓度氧气吸入对于预防外科手术部位感染的临床作用尚不清楚，主要由于该领域中随机对照试验的结论并不一致。本系统性回顾的目的在于探讨围手术期高浓度氧气吸入能否降低手术刀口感染的风险。方法 2010年7月12日，我们针对国家医学图书馆Medline数据库（见附录1）、Cochrane 中心CENTRAL数据库、EMBASE数据库资料进行了电子检索，入选评估成年患者围手术期感染的随机、对照研究，要求文献中包含高浓度氧气吸入组与低浓度吸氧组或对照组的比较。我们主要研究结果（外科感染）是汇总资料比值比的95%可信区间，应用Cochrane Collaboration’s RevMan 5.0.25版本软件(Cochrane Collaboration, Oxford, UK)，并采用随机效应模型进行计算。结果 文献检索最终入选包含2728例患者的7个临床试验，随机分为高氧组1358例，对照组1370例。高氧组总感染率为15.5%，对照组为17.5%。高氧组术野感染率的比值比为0.85（95%置信区间为0.52, 1.38）（P = 0.51）。但2个亚组（全麻和结直肠手术亚组）的分析结果显示，高浓度氧气吸入有助于减少手术刀口感染。结论 基于本荟萃分析，总体来看围手术期吸入高浓度氧并不能预防刀口感染。但2个亚组（全麻和结直肠手术亚组）的阳性结果表明，高浓度氧可降低围手术期刀口感染的发生率。目前，仍需进一步的研究对高浓度吸氧的作用加以探讨。 Abstract BACKGROUND The clinical role of hyperoxia for preventing surgical site infection remains uncertain because randomized controlled trials on this topic have reported disparate results. Our objective in this systematic review was to determine whether perioperative hyperoxia reduces surgical site infection. METHODS An electronic search was conducted using the National Library of Medicine’s MEDLINE, Cochrane Collaboration’s CENTRAL, and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of high oxygen versus low oxygen or control, and with a documented assessment for perioperative infection. Pooled estimates for odds ratios (ORs) with 95% confidence intervals were obtained for our primary outcome (surgical site infection) using the Cochrane Collaboration’s RevMan version 5.0.25 (Cochrane Collaboration, Oxford, UK). ORs were calculated using a random effects model. RESULTS The literature search ultimately yielded 7 trials, enrolling 2728 patients, that were included in the analysis. There were 1358 pat