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meta分析表明，手术室层流通风不能减少手术部位感染
2017年05月28日 ⁄ 时讯速递,
Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis
Peter Bischoff, Peter Bischoff, N Zeynep Kubilay, et al
Lancet Infect Dis 2017; 17: 553-561
DOI: http://dx.doi.org/10.1016/S1473-3099(17)30059-2
Summary
Background 背景
The role of the operating room's ventilation system in the prevention of surgical site infections (SSIs) is widely discussed, and existing guidelines do not reflect current evidence. In this context, laminar airflow ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSIs.
手术室通风系统对于预防手术部位感染(SSIs)的作用受到了广泛讨论，但现有指南并未反映当前的证据。我们比较了层流通风与传统通风系统对减少SSIs风险的影响。
Methods 方法
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and WHO regional medical databases from Jan 1, 1990, to Jan 31, 2014. We updated the search for MEDLINE for the period between Feb 1, 2014, and May 25, 2016. We included studies most relevant to our predefined question: is the use of laminar airflow in the operating room associated with the reduction of overall or deep SSI as outcomes in patients of any age undergoing surgical operations? We excluded studies not relevant to the study question, studies not in the selected languages, studies published before Jan 1, 1990, or after May 25, 2016, meeting or conference abstracts, and studies of which the full text was not available. Data were extracted by two independent investigators, with disagreements resolved through further discussion. Authors were contacted if the full-text article was not available, or if important data or information on the paper's content was absent. Studies were assessed for publication bias. Grading of recommendations assessment, development, and evaluation was used to assess the quality of the identified evidence. Meta-analyses were done with RevMan (version 5.3).
我们检索了MEDLINE, Embase, Cochrane Central Register of Controlled Trials, 以及 WHO 局部医学数据库1990年1月1日至2014年1月31日之间的数据。我们又更新了2014年2月1日至2016年5月25日期间MEDLINE的检索结果。我们入选了与事先确定的问题最为相关的研究：手术室采用层流通风系统是否伴随任何年龄的外科患者总体及深部SSIs的减少？我们排除了与研究问题无关的试验，未以特定语言发表的研究，1990年1月1日前及2016年5月25日以后发表的研究，会议摘要，以及无法追溯全文的研究。两名研究者独立获取数据，并通过讨论解决两人的不一致。如果没有全文或论文中缺失重要数据或信息，研究者会联系作者。对研究的发表偏倚进行评估。采用GRADE系统评价证据质量。采用RevMan软件进行meta分析。
Findings 结果
We identified 1947 records of which 12 observational studies were comparing laminar airflow ventilation with conventional turbulent ventilation in orthopaedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (330 146 procedures, odds ratio [OR] 1·29, 95% CI 0·98–1·71; p=0·07, I2=83%). For total knee arthroplasty, the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (134 368 procedures, OR 1·08, 95% CI 0·77–1·52; p=0·65, I2=71%). For abdominal and open vascular surgery, the meta-analysis of three cohort studies found no difference in risk for overall SSIs (63 472 procedures, OR 0·75, 95% CI 0·43–1·33; p=0·33, I2=95%).
我们共检索到1947项研究，其中12项研究比较了层流通风系统与传统湍流通风系统对骨科、腹部外科及血管外科手术的影响。对8项队列研究的meta分析显示，手术室通风系统对全髋关节成型术后深部SSIs的风险没有影响（330 146例次手术，比数比 [OR] 1·29, 95% CI 0·98–1·71; p=0·07, I2=83%）。对于全膝关节成型手术而言，6项队列研究的meta分析显示深部SSIs的风险并无差异（134 368 例次手术，OR 1·08, 95% CI 0·77–1·52; p=0·65, I2=71%）。对于腹部外科手术及开放性血管外科手术，3项队列研究的meta分析未发现总SSIs的风险存在显著差异（63 472 例次手术，OR 0·75, 95% CI 0·43–1·33; p=0·33, I2=95%）。
Interpretation 结论
The available evidence shows no benefit for laminar airflow compared with conventional turbulent ventilation of the operating room in reducing the risk of SSIs in total hip and knee arthroplasties, and abdominal surgery. Decision makers, medical and administrative, should not regard laminar airflow as a preventive measure to reduce the risk of SSIs. Consequently, this equipment should not be installed in new operating rooms.
现有证据表明，与传统湍流通风系统相比，手术室层流通风系统对于减少全髋或全膝关节成型术、腹部外科手术SSIs的风险并无益处。决策者、医疗管理者不应将层流通风系统作为减少SSIs风险的预防措施。因此，手术室不应安装这一设备。
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发表于 2017-6-23 07:56
