肺癌术后不同时机拔除胸腔引流管临床结局比较的网状Meta分析

doi:10.3877/cma.j.issn.1674-6902.2022.06.004

目的

采用网状Meta分析方法系统评价肺癌术后24 h引流量<100 ml、200 ml、300 ml、400 ml不同时机拔管的临床结局。

方法

在PubMed、EMBASE、The Cochrane Library、Web of Science以及中文数据库万方、CBM、CNKI检索关于肺癌术后不同时机拔管的随机对照试验(randomized controlled trial, RCT)，检索时限从建库到2019年11月。按照纳入标准进行文献筛选、数据提取及质量评价后，采用stata 14.0和Review Manage软件进行网状Meta分析。

结果

通过直接Meta分析发现胸腔积液100 ml与300 ml(RR：0.41，95%CI：0.19~0.90，P＝0.03)；二次置管100 ml与300 ml比较(RR：0.43，95%CI：0.19~0.97，P＝0.04)；100 ml与200 ml比较(MD：1.70，95%CI：0.57~2.82，P＝0.003)；100 ml与300 ml比较(MD：2.32，95%CI：1.31~3.33，P<0.001)；200 ml与300 ml比较(MD：1.68，95%CI：1.34~2.01，P<0.001)。

结论

胸腔引流液拔除管道住院时间短，相比并发症高。胸腔引流液100 ml时拔除胸腔闭式引流管，并发症发生率低，胸腔引流液150 ml时拔除为最佳时间。

关键词: 支气管肺癌, 网状Meta分析, 胸腔引流, 拔管时机

Objective

To systematically evaluate and analyze the clinical outcomes of extubation at different times when the drainage volume of lung cancer is less than 100 ml, 200 ml, 300 ml, 400 ml 24 hours after operation by using reticular Meta-analysis.

Methods

randomized controlled trial (RCT) of extubation at different times after lung cancer surgery was searched in PubMed, EMBASE, The Cochrane Library, Web of Science and Chinese databases Wanfang, CBM and CNKI. The search time was from the establishment of the database to November 2019. Two researchers conducted literature screening, data extraction and quality evaluation according to the inclusion criteria, and then used stata 14.0 and Review Manage software to conduct network Meta-analysis.

Results

Through direct meta-analysis, the pleural effusion was 100 ml and 300 ml (RR: 0.41, 95%CI: 0.19~0.90, P=0.03). 100 ml of secondary catheter was compared with 300 ml (RR: 0.43, 95%CI: 0.19~0.97, P=0.04); 100 ml compared with 200 ml (MD: 1.70, 95%CI: 0.57~2.82, P=0.003); 100 ml compared with 300 ml (MD: 2.32, 95%CI: 1.31~3.33, P<0.001); 200 ml compared with 300 ml(MD: 1.68, 95%CI: 1.34~2.01, P<0.001).

Conclusion

The more pleural drainage fluid, the shortest hospitalization time after removing the tube, but the highest complications. When the thoracic drainage fluid is 100ml, the closed thoracic drainage tube is removed, and the complication rate is the lowest, but the hospitalization time is long. Therefore, according to the analysis of the final data in this paper, it is the best scheme to remove the pleural fluid when it is 150 ml.

Key words: Bronchogenic carcinoma, Reticular Meta-analysis, Thoracic drainage, Extubation

表1 纳入具体信息

作　者	年份	引流液量(ml)	例数	性别(男/女)	拔管后并发症	术后住院时间(d)
吴斌^[25]	2018	100	28		5	7.5±1.1
		200	22		4	5.0±1.3
		300	27		6	4.8±1.2
李昀^[26]	2015	100	30	17/13	4	9.2±2.01
		300	30	19/11	5	7.97±1.54
张晔^[23]	2013	100	29	14/15	0	6
		300	41	21/20	12	5
周景海^[20]	2019	100	45		4	19.0±9.7
		200	41		2	14.0±8.0
		300	41		3	9.0±4.8
张卫强^[22]	2015	100	88	56/32	7	9.0±1.7
		300	78	52/26	8	5.0±2.3
李伟^[24]	2014	100	50		2	7.2±2.4
		300	48		10	5.8±2.1
孙光亚^[19]	2019	200	50	31/19	14	9.84±1.05
		300	50	33/17	3	7.05±1.33
闵波^[18]	2019	100	42	25/17	10
		400	34	19/15	7
王颖琦^[21]	2013	100	60	33/22	6	10.68±2.36
		300	55	36/24	9	11.48±2.10
韩洪利^[10]	2015	100	90	56/34	21	11.47±1.90
		200	87	52/35	25	10.68±2.50
		300	83	49/34	23	10.23±2.14
Ye Zhang^[15]	2014	100	29	21/20	1	6.71±1.56
		300	41	14/15	7	5.35±0.77
Younes，Riad N^[9]	2002	100	44	32/12	5	6.84±7.66
		150	58	37/21	8	5.47±5.40
		200	37	28/9	3	5.47±5.40
Mohammad Ali Hessami^[17]	2009	150	70	47/23	3	4.8±1.7
		200	68	54/14	3	4.1±1.58
Hong-Ya Xie^[16]	2015	150	49	36/13	0	7.5±1.1
		300	50	32/18	3	4.8±1.1
		400	51	34/17	21	4.8±1

表1 纳入具体信息

作　者	年份	引流液量(ml)	例数	性别(男/女)	拔管后并发症	术后住院时间(d)
吴斌^[25]	2018	100	28		5	7.5±1.1
		200	22		4	5.0±1.3
		300	27		6	4.8±1.2
李昀^[26]	2015	100	30	17/13	4	9.2±2.01
		300	30	19/11	5	7.97±1.54
张晔^[23]	2013	100	29	14/15	0	6
		300	41	21/20	12	5
周景海^[20]	2019	100	45		4	19.0±9.7
		200	41		2	14.0±8.0
		300	41		3	9.0±4.8
张卫强^[22]	2015	100	88	56/32	7	9.0±1.7
		300	78	52/26	8	5.0±2.3
李伟^[24]	2014	100	50		2	7.2±2.4
		300	48		10	5.8±2.1
孙光亚^[19]	2019	200	50	31/19	14	9.84±1.05
		300	50	33/17	3	7.05±1.33
闵波^[18]	2019	100	42	25/17	10
		400	34	19/15	7
王颖琦^[21]	2013	100	60	33/22	6	10.68±2.36
		300	55	36/24	9	11.48±2.10
韩洪利^[10]	2015	100	90	56/34	21	11.47±1.90
		200	87	52/35	25	10.68±2.50
		300	83	49/34	23	10.23±2.14
Ye Zhang^[15]	2014	100	29	21/20	1	6.71±1.56
		300	41	14/15	7	5.35±0.77
Younes，Riad N^[9]	2002	100	44	32/12	5	6.84±7.66
		150	58	37/21	8	5.47±5.40
		200	37	28/9	3	5.47±5.40
Mohammad Ali Hessami^[17]	2009	150	70	47/23	3	4.8±1.7
		200	68	54/14	3	4.1±1.58
Hong-Ya Xie^[16]	2015	150	49	36/13	0	7.5±1.1
		300	50	32/18	3	4.8±1.1
		400	51	34/17	21	4.8±1

图1 PRISMA流程图

表3 不同拔管时机有效性的等级排序概率

术后并发症
Drug	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5	Drug
100	0.01	0.14	0.29	0.38	0.18	100
150	0.01	0.11	0.1	0.14	0.64	150
200	0.03	0.3	0.26	0.29	0.12	200
300	0.03	0.41	0.32	0.18	0.06	300
400	0.93	0.04	0.02	0.01	0.01	400

表3 不同拔管时机有效性的等级排序概率

术后并发症
Drug	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5	Drug
100	0.01	0.14	0.29	0.38	0.18	100
150	0.01	0.11	0.1	0.14	0.64	150
200	0.03	0.3	0.26	0.29	0.12	200
300	0.03	0.41	0.32	0.18	0.06	300
400	0.93	0.04	0.02	0.01	0.01	400

图2 术后并发症的直接比较森林图

表5 不同拔管时机有效性的等级排序概率

术后住院时间
Drug	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5	Drug
100	0.55	0.32	0.11	0.02	0	100
150	0.33	0.34	0.24	0.07	0.02	150
200	0.07	0.27	0.49	0.15	0.03	200
300	0	0.01	0.07	0.53	0.38	300
400	0.05	0.06	0.09	0.23	0.58	400

表5 不同拔管时机有效性的等级排序概率

术后住院时间
Drug	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5	Drug
100	0.55	0.32	0.11	0.02	0	100
150	0.33	0.34	0.24	0.07	0.02	150
200	0.07	0.27	0.49	0.15	0.03	200
300	0	0.01	0.07	0.53	0.38	300
400	0.05	0.06	0.09	0.23	0.58	400

图3 术后住院时间的直接比较森林图

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Comparative effectiveness of different movement therapies for improving upper motor function in children with hemiplegic cerebral palsy: A network Meta-analysis

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Comparative effectiveness of different movement therapies for improving upper motor function in children with hemiplegic cerebral palsy: A network Meta-analysis