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目的评价中心静脉导管联合负压吸引行胸腔闭式引流术治疗自发性气胸的临床疗效。方法计算机检索PubMed、OVID、CNKI、万方数据库、超星数字图书馆、中国生物医学文献数据库(CMB)以及百度和Google搜索引擎,纳入中心静脉导管联合负压吸引与传统胸腔闭式引流比较治疗自发性气胸的RCT,检索日期从每个数据库建库至2014年9月15日。由两名研究者严格按照纳入与排除标准进行文献筛选,依据Cochrane协助网提供的标准评价文献质量及偏倚风险,采用RevMan5.3软件对数据进行管理和统计分析。结果纳入18篇文献共1 549例患者,中心静脉导管组与传统胸腔闭式引流组相比较肺复张时间[SMD=0.01,95%CI(-0.23,0.25),P<0.95]、住院时间[SMD=-0.42,95%CI(-1.81,0.97),P=0.55]、治愈率[RR=1.04,95%CI(1.00,1.08),P=0.07]差异无统计学意义并发症发生率_RR=0.31,95%CI(0.23,0.43),P<0.000 01]中心静脉导管组低于传统胸腔闭式引流组,且差异有统计学意义。结论中心静脉导管联合负压吸引行胸腔闭式引流术是一种简便、安全的方法。但由于本研究纳入的文献质量不高个别文献样本量较小,尚需大样本高质量的临床RCT进一步验证。
Objective To evaluate the clinical effect of central venous catheter combined with negative pressure suction on thoracic closed drainage in the treatment of spontaneous pneumothorax. Methods PubMed, OVID, CNKI, Wanfang database, Superstar digital library, China Biomedical Literature Database (CMB) and Baidu and Google search engine were included in the study. The patients were treated with central venous catheter combined with negative pressure suction and traditional thoracic closure drainage Pneumothorax RCT, retrieval date from each database building to September 15, 2014. Two researchers screened the literature strictly in accordance with inclusion and exclusion criteria, assessed the quality of the literature and the risk of bias based on the criteria provided by the Cochrane Helpline, and used RevMan 5.3 software to manage and statistically analyze the data. Results A total of 1 549 patients were enrolled in 18 articles. Compared with the traditional thoracic drainage group, the central venous catheter group showed longer time of lung recruitment [SMD = 0.01, 95% CI (-0.23, 0.25), P <0.95] There was no significant difference in the cure rate [RR = 1.04, 95% CI (1.00, 1.08), P = 0.07] RR = 0.31, 95% CI (0.23, 0.43), P <0.000 01] The central venous catheter group was lower than the conventional closed thoracic drainage group, and the difference was statistically significant. Conclusions Central venous catheter combined with negative pressure suction is a simple and safe method for closed thoracic drainage. However, due to the low quality of literature included in this study and the small sample size of individual literatures, large samples of high quality clinical RCTs are yet to be further validated.