Lancet最新meta分析：层流技术与常规通气方式相比并未改善手术部位感染

本帖最后由 doublly 于 2017-2-27 09:11 编辑


柳叶刀杂志2月16日发表一篇关于《层流技术对手术部位感染的影响》的系统综述，与常规方式相比较，使用层流技术并未明显改善手术部位感染的发生率。摘要如下，供参考（全文已附，另外一篇对本文章的述评也附上）：


同期一篇述评也说道：虽然本文纳入的文献仅仅是观察性研究，而且存在严重的异质性，因此需要更高质量的研究；但从其结果来看，未能提供支持使用层流技术的有效证据。因此，结合层流技术的高维护费用，不支持在手术室内使用层流技术来预防SSIs。

中文摘要摘译：


背景

手术室的通风系统在预防手术部位感染（SSIs）的角色引发广泛争议，现有的指南并未采纳最新证据。本文比较了层流技术与常规通风方式在降低手术部位感染方面的有效性。

方法

作者系统搜索了从1990年1月1日-2014年1月31日 MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and WHO regional medical等数据库，从2014年2月1日-2016年5月25日更新搜索了medline。作者预先设定一个问题：即手术室内使用层流技术是否与行手术治疗患者的手术部位感染降低有关？凡是与此问题相关的研究均纳入本系统综述，与此问题无关或其他相关因素无关者即排除。

结果

本文共纳入12项观察研究。

结论

已有证据显示，与常规通风方式相比，手术室内使用层流技术在降低关节矫形手术和腹部手术部位感染方面并未显示出其优越性。相关方面不应把层流技术应用作为降低SSI发生的预防手段。因此，层流技术不应安装于新的手术室。



Summary

Background

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.


Methods

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).


Findings

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%).


Interpretation

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.