系統性探討氣囊漏氣試驗對拔管後喘鳴音與重插管發生率以及相關因素的預測：統合分析

Systematic Review to Explore the Cuff Leak Test for Predicting the Incidences of post-extubated Stridor and re-intubation and Relative Factors: A meta-analysis

鄭瑞駿(Jui-Chun Cheng) ； 王敏華(Min-Hua Wang) ； 陳雅莉(Ya-Li Chen) ； 林美妙(Mei-Miao Lin) ； 徐曼瑩(Man-Ying Fang Hsu)

《呼吸治療》 9卷2期 (2010/07) Pp. 1-15

https://doi.org/10.6269/JRT.2010.9.2.01

摘要

研究目的：本研究以系統性方式回顧過去的研究，探討漏氣試驗對拔管後喘鳴音(stridor)與重插管的發生率以及相關因素，爲一項統合性研究。
研究方法：有系統的搜尋資料庫以及網站篩選符合標準的研究文章，使用MedCalc Software進行統合分析。
研究結果：整體拔管後喘鳴發生率和重插管率分別爲5.4%和6.0%；各研究的敏感度、專一度、正向預測值、和負向預測值的預測分別爲0%~88.6%、72%~99%、0%~83.8%、89.9%~99%；整體漏氣量與拔管後發生喘鳴的標準化平均差異(SMD)爲－1.308（95%信賴區間－1.766~-0.850）；喘鳴與無喘鳴病人插管天數的標準化平均差異(SMD)爲0.382（95%信賴區間0.0615~-0.703）；拔管後產生喘鳴音病人之內管氣管直徑／喉部直徑比率之結果分歧；氣囊漏氣試驗對女性拔管後產生喘鳴音的統合勝算比爲2.647（95%信賴區間爲1.674 to 4.185）；「發生喘鳴音病人」對「無發生喘鳴音病人」重插管的統合勝算比爲44.365（95%信賴區間爲25.032 to 78.631）。
結論：氣囊漏氣測試（小於漏氣閾值）可以預測病人拔管後喘鳴音以及重插管的發生。沒有通過漏氣測試的病人比有通過測試的病人有較高的機會產生拔管後的喘鳴音。拔管後發生喘鳴音的病人，其插管天數明顯比無發生喘鳴音的病人長。大的「內管氣管直徑／喉部直徑比率」是否會有較高的喘鳴發生，需要有進一步的研究來確認。女性（與男性相比）確實是拔管後發生喘鳴音的一個危險因子。發生喘鳴音病人的重插管機率的確比無發生喘鳴音病人高。

關鍵字

氣囊漏氣測試 ； 喘鳴音 ； 拔管 ； 重插管

並列摘要

Purpose: Systematic reviewing of studies and meat-analysis about the cuff-leak test for predicting the incidences of post-extubated stridor and re-intubation.
Methods: Systematic research on electronic databases and screening adequate studies according to our criteria. Using of MedCalc Software be our tool for meta-analysis.
Results: The incidences of post-extubation and re-intubation of whole patients were 5.4% and 6% respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 0%~88.6%、72%~99%、0%~83.8%、89.9%~99% in each study respectively. The standardized mean difference (SMD) of meta-analysis for leak volume between stridor group and non-stridor group was -1.308(95%CI-1.766~-0.850). The SMD of meta-analysis for duration of intubation between the stridor group and the non-stridor group was 0.382(95%CI 0.0615~-0.703). The ratios of endotracheal tube size to laryngeal diameter were different in two studies. The meta-analysis odds ratio for cuff-leak test was 2.647(95%CI 1.674 to 4.185) in female gender. The meta-analysis odds ratio for re-intubation was 44.365 (95%CI 25.032 to 78.631) in comparison of the stridor with the non-stridor.
Conclusion: The cuff-leak test (small leak) can be used to predict the incidences of post-extubation and re-intubation. The incidence of post-extubation was higher in the negative cuff-leak group than the positive cuff-leak. The duration of intubation was longer in the stridor group than the non-stridor group. We need further to identify if the higher incidence was developed in the higher ratio of endotracheal tube size to laryngeal diameter. Female gender was exactly the risk of occurrence of post-extubation. And, the possibility of re-intubation was higher in the stridor group than in the non-stridor group.

並列關鍵字

cuff leak test ； stridor ； stridor ； re-intubation