Fiberoptic bronchoscopy for stroke-associated pneumonia: a meta-analysis_West China Medical Journal

Authors：

ZHANG Yang ^1,2 , HUA Tianfeng ^1,2 , ZHENG Yao ^1,2 , LI Hui ^1,2 ,  YANG Min ^1,2

1. The Second Department of Intensive Care Unit, No. 2 Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230601, P. R. China;
2. The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P. R. China;

Corresponding?author：

YANG Min, Email: 512130761@qq.com

Keywords：

Fiberoptic bronchoscopy; Stroke-associated pneumonia; Meta-analysis

DOI：

10.7507/1002-0179.201901045

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ObjectiveTo systematically evaluate the efficacy of fiberoptic bronchoscopy for patients with stroke-associated pneumonia (SAP).MethodsAll randomized controlled trials on fiberoptic bronchoscopy in treating SAP were collected from Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese Biology Medicine database, Wanfang database, and Chongqing VIP database. Two reviewers screened the literature, extracted data, and assessed the methodological quality of included studies. And then meta-analysis was conducted using RevMan 5.3 software.ResultsTwelve studies with 1 107 patients were included. Compared with the routine therapy, the fiberoptic bronchoscopy combined with routine therapy showed a better efficacy [relative risk (RR)=1.26, 95% confidence interval (CI) (1.17, 1.36), P<0.000 01], and indicated a shorter hospital-stay [mean difference (MD)=–4.29 days, 95%CI (–5.06, –3.52) days, P<0.000 01] and lower Clinical Pulmonary Infection Score values [MD=–1.13, 95%CI (–1.77, –0.49), P=0.000 5]. Meanwhile, a downward trend in the level of procalcitonin [standardized mean difference (SMD)=–3.86, 95%CI (–4.22, –3.50), P<0.000 01], tumor necrosis factor α [SMD=–2.75, 95%CI (–3.84, –1.66), P<0.000 01], and C-reactive protein [SMD=–2.55, 95%CI (–3.83, –1.26), P=0.000 1], as well as a higher level of partial pressure of oxygen in arterial blood [MD=15.34 mm Hg (1 mm Hg=0.133 kPa), 95%CI (6.38, 24.31) mm Hg, P=0.000 8] appeared after the combined treatment.ConclusionBased on the conventional therapy, the treatment of fiberoptic bronchoscopy can improve the efficacy, shorten the hospital stay, relieve the systemic inflammatory responses, and improve the oxygenation of SAP patients.

Citation： ZHANG Yang, HUA Tianfeng, ZHENG Yao, LI Hui, YANG Min. Fiberoptic bronchoscopy for stroke-associated pneumonia: a meta-analysis. West China Medical Journal, 2019, 34(1): 66-73. doi: 10.7507/1002-0179.201901045 Copy

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2.	卒中相關性肺炎診治中國專家共識組. 卒中相關性肺炎診治中國專家共識. 中華內科雜志, 2010, 49(12): 1075-1078.
3.	韓秋, 李靖, 沈軍, 等. 床旁纖支鏡輔助治療老年卒中相關性肺炎的研究. 臨床肺科雜志, 2016(3): 450-452.
4.	劉鴻儒. 氣管鏡聯合氨溴索霧化吸入治療卒中相關性肺炎的臨床分析. 臨床醫學研究與實踐, 2017, 2(12): 17-18.
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7.	安曉潔, 乜慶榮, 鄧趕飛, 等. 纖維支氣管鏡肺泡灌洗治療社區獲得性卒中相關性肺炎療效觀察. 新鄉醫學院學報, 2014, 31(5): 368-370.
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9.	凌濤, 黃聃, 孫大勇. 便攜式纖支鏡肺泡灌洗輔助治療重癥卒中相關性肺炎的研究. 嶺南急診醫學雜志, 2017, 22(3): 234-236.
10.	李麗榮, 曾祥毅, 巫劍峰, 等. 早期床旁纖維支氣管鏡吸痰及肺泡灌洗在卒中相關性肺炎患者中的應用. 臨床醫學, 2012, 32(6): 4-6.
11.	宋學紅, 陳建霞. 支氣管鏡吸痰治療卒中相關性肺炎的臨床觀察. 中國急救醫學, 2017, 37(11): 212-213.
12.	許名遠, 鐘林清, 龔振斌, 等. 床旁纖支鏡吸痰及肺泡灌洗在老年卒中相關性肺炎治療中的效果觀察. 中外醫學研究, 2016, 14(36): 13-14.
13.	唐璐, 張智博, 彭旭. 纖維支氣管鏡肺泡灌洗吸痰術治療卒中相關性肺炎的有效性分析. 延邊醫學, 2014, 25: 49-51.
14.	曹玉芝. 支氣管肺泡灌洗術輔助治療卒中相關性肺炎的臨床分析. 中國醫師進修雜志, 2014, 37(16): 68-69.
15.	Hsia DW, Tanner NT, Shamblin C, et al. The latest generation in flexible bronchoscopes: a description and evaluation. J Bronchology Interv Pulmonol, 2013, 20(4): 357-362.
16.	Thakkar MS, von Groote-Bidlingmaier F, Bolliger CT. Recent advances in therapeutic bronchoscopy. Swiss Med Wkly, 2012, 142(142): w13591.
17.	鄧星奇, 李艷艷, 顧薇, 等. 臨床肺部感染評分在卒中相關性肺炎患者預后評估中的作用. 蚌埠醫學院學報, 2014, 39(2): 198-201.

1. Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 2003, 34(4): 975-981.
2. 卒中相關性肺炎診治中國專家共識組. 卒中相關性肺炎診治中國專家共識. 中華內科雜志, 2010, 49(12): 1075-1078.
3. 韓秋, 李靖, 沈軍, 等. 床旁纖支鏡輔助治療老年卒中相關性肺炎的研究. 臨床肺科雜志, 2016(3): 450-452.
4. 劉鴻儒. 氣管鏡聯合氨溴索霧化吸入治療卒中相關性肺炎的臨床分析. 臨床醫學研究與實踐, 2017, 2(12): 17-18.
5. 張群, 李瑞萍, 郭輝, 等. 氣管鏡聯合氨溴索治療卒中相關性肺炎的臨床分析. 臨床醫藥文獻電子雜志, 2017, 4(39): 7702-7703.
6. 郭宏杰. 氣管鏡聯合氨溴索治療卒中相關性肺炎的臨床研究. 社區醫學雜志, 2016, 14(2): 19-21.
7. 安曉潔, 乜慶榮, 鄧趕飛, 等. 纖維支氣管鏡肺泡灌洗治療社區獲得性卒中相關性肺炎療效觀察. 新鄉醫學院學報, 2014, 31(5): 368-370.
8. 張遂甫, 段沖亞, 連廣學, 等. 纖支鏡聯合氨溴索肺泡灌洗在老年卒中相關性肺炎中的應用. 社區醫學雜志, 2017, 15(19): 16-18, 21.
9. 凌濤, 黃聃, 孫大勇. 便攜式纖支鏡肺泡灌洗輔助治療重癥卒中相關性肺炎的研究. 嶺南急診醫學雜志, 2017, 22(3): 234-236.
10. 李麗榮, 曾祥毅, 巫劍峰, 等. 早期床旁纖維支氣管鏡吸痰及肺泡灌洗在卒中相關性肺炎患者中的應用. 臨床醫學, 2012, 32(6): 4-6.
11. 宋學紅, 陳建霞. 支氣管鏡吸痰治療卒中相關性肺炎的臨床觀察. 中國急救醫學, 2017, 37(11): 212-213.
12. 許名遠, 鐘林清, 龔振斌, 等. 床旁纖支鏡吸痰及肺泡灌洗在老年卒中相關性肺炎治療中的效果觀察. 中外醫學研究, 2016, 14(36): 13-14.
13. 唐璐, 張智博, 彭旭. 纖維支氣管鏡肺泡灌洗吸痰術治療卒中相關性肺炎的有效性分析. 延邊醫學, 2014, 25: 49-51.
14. 曹玉芝. 支氣管肺泡灌洗術輔助治療卒中相關性肺炎的臨床分析. 中國醫師進修雜志, 2014, 37(16): 68-69.
15. Hsia DW, Tanner NT, Shamblin C, et al. The latest generation in flexible bronchoscopes: a description and evaluation. J Bronchology Interv Pulmonol, 2013, 20(4): 357-362.
16. Thakkar MS, von Groote-Bidlingmaier F, Bolliger CT. Recent advances in therapeutic bronchoscopy. Swiss Med Wkly, 2012, 142(142): w13591.
17. 鄧星奇, 李艷艷, 顧薇, 等. 臨床肺部感染評分在卒中相關性肺炎患者預后評估中的作用. 蚌埠醫學院學報, 2014, 39(2): 198-201.

West China Medical Journal

Fiberoptic bronchoscopy for stroke-associated pneumonia: a meta-analysis

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