机械性吸呼气技术对接受机械通气的危重症患者临床结局的影响：一项系统综述与荟萃分析。
完整摘要 · 中文译文
本系统评价和荟萃分析旨在评估机械性吸-呼气（MI-E）与常规护理相比在机械通气的危重成人患者中的临床疗效。# 方法 我们检索了Embase、通过PubMed检索的MEDLINE、CINAHL和Cochrane Library，纳入截至2026年4月发表的、在机械通气成人中比较MI-E与常规护理的随机对照试验（RCT）。主要结局为机械通气持续时间。次要结局包括吸引的气道分泌物量、呼吸系统顺应性、气道阻力、ICU住院时间和死亡率。当至少两项研究提供临床和方法学上可比的数据时进行荟萃分析。采用GRADE方法评估证据确定性。# 结果 共纳入6项RCT，涉及492名参与者。对于主要结局机械通气持续时间，仅1项RCT贡献了效应估计值（MD，-2.67天；95% CI，-6.91至1.57；极低确定性证据）。与常规护理相比，MI-E增加了吸引的气道分泌物量（MD，1.47 g；95% CI，0.74至2.19；极低确定性证据）。在呼吸系统顺应性或气道阻力方面未观察到统计学显著差异。ICU住院时间也显示无差异（2项RCT；MD，-1.75天；95% CI，-4.61至1.10；极低确定性证据）。死亡率由1项RCT评估（风险比，1.56；95% CI，0.44至5.50；极低确定性证据）。# 结论 MI-E对m的临床结局的影响 机械通气的危重患者仍不确定，因为现有证据的确定性为低至极低。机械性吸呼气（MI-E）可能改善气道分泌物清除；然而，关于机械通气时长、ICU住院时间和死亡率的证据仍非常不确定。需要进一步开展高质量的随机对照试验。
完整摘要 · 英文原文
This systematic review and meta-analysis aimed to evaluate the clinical efficacy of mechanical insufflation-exsufflation (MI-E) compared with usual care in mechanically ventilated critically ill adults. # Methods We searched Embase, MEDLINE via PubMed, CINAHL, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2026 that compared MI-E with usual care in mechanically ventilated adults. The primary outcome was duration of mechanical ventilation. Secondary outcomes included the amount of aspirated airway secretions, respiratory system compliance, airway resistance, length of ICU stay, and mortality. Meta-analysis was performed when at least two studies provided clinically and methodologically comparable data. The certainty of evidence was assessed using the GRADE approach. # Results Six RCTs involving 492 participants were included. For the primary outcome of mechanical ventilation duration, only one RCT contributed to the effect estimate (MD, -2.67 days; 95% CI, -6.91 to 1.57; very-low-certainty evidence). MI-E increased the amount of aspirated airway secretions compared with usual care (MD, 1.47 g; 95% CI, 0.74 to 2.19; very-low-certainty evidence). No statistically significant differences were observed in respiratory system compliance or airway resistance. ICU length of stay also showed no difference (2 RCTs; MD, -1.75 days; 95% CI, -4.61 to 1.10; very-low-certainty evidence). Mortality was evaluated by one RCT (risk ratio, 1.56; 95% CI, 0.44 to 5.50; very-low-certainty evidence). # Conclusions The effects of MI-E on clinical outcomes in mechanically ventilated critically ill patients remain uncertain because the available evidence is of low to very low certainty. MI-E may improve airway secretion clearance; however, evidence regarding mechanical ventilation duration, ICU length of stay, and mortality remains very uncertain. Further high-quality randomized controlled trials are required.