中国循证医学杂志

中国循证医学杂志

头罩式无创正压通气对成人急性呼吸衰竭疗效的 Meta 分析

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目的 系统评价头罩式无创正压通气对成人急性呼吸衰竭患者疗效的影响。 方法 计算机检索 PubMed、The Cochrane Library(2016 年 11 期)、Web of Science、EMbase、CBM、CNKI、WanFang Data,搜集关于头罩式无创正压通气(NPPV)治疗急性呼吸衰竭的随机对照试验(RCT)或队列研究,检索时限均为建库至 2016 年 11 月。由两名研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用 Stata 12.0 软件进行 Meta 分析。 结果 最终纳入 8 个研究。Meta 分析结果显示,头罩式 NPPV 能够显著降低 ARF 患者的 PaCO2[队列研究:SMD=–0.46,95%CI(–0.75,–0.18),P=0.001]、气管插管率 [RCT:OR=0.36,95%CI(0.17,0.77),P=0.008]和住院期间死亡率[RCT:OR=0.48,95%CI(0.24,0.98),P=0.044],提高呼吸末正压[RCT:SMD=1.27,95%CI(0.87,1.67),P<0.05]和改善呼吸频率[RCT:SMD=–0.45,95%CI(–0.81,–0.08),P=0.017];两组在 NPPV 治疗时间方面无明显差异[队列研究:OR=–0.20,95%CI(–0.50,0.09),P=0.177;RCT:OR=–0.24,95%CI(–0.86,0.38),P=0.445]。 结论 头罩式 NPPV 治疗 AFR 可降低患者 PaCO2、气管插管率、住院期间死亡率,提高呼吸末正压及改善呼吸状况方面具有优势,但在提高 PaO2/FiO2、缩短 NPPV 治疗时间方面的效果尚不能确定。受纳入研究的数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure. Methods Randomized controlled trials (RCTs) or cohort studies about noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure were retrieved in PubMed, The Cochrane Library (Issue 11, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data databases from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Stata 12.0 software was then used to perform meta-analysis. Results A total of eight studies were included. The results of meta-analysis showed that, NPPV by helmet could significantly reduce the carbon dioxide partial pressure (cohort study: SMD=–0.46, 95%CI –0.75 to –0.18, P=0.001), tracheal intubation rate (RCT: OR=0.36, 95%CI 0.17 to 0.77, P=0.008) and hospital mortality (RCT: OR=0.48, 95%CI 0.24 to 0.98, P=0.044), improve the positive end expiratory pressure (RCT: SMD=1.27, 95%CI 0.87 to 1.67, P<0.05) and respiratory status (RCT: SMD=–0.45, 95%CI –0.81 to –0.08,P=0.017). There was no significant difference in the duration of NPPV(cohort study: OR=–0.20, 95%CI –0.50 to 0.09, P=0.177; RCT: OR=–0.24, 95%CI –0.86 to 0.38, P=0.445). Conclusion NPPV by helmet can reduce the carbon dioxide partial pressure, tracheal intubation rate, hospital mortality and improve the positive end expiratory pressure, respiratory status. But the effects in the duration of NPPV and oxygenation index are uncertain. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 头罩; 无创正压通气; 急性呼吸衰竭; 队列研究; 随机对照试验; Meta 分析

Key words: Helmet; Noninvasive positive pressure ventilation; Acute respiratory failure; Cohort study; Randomized controlled trial; Meta-analysis

引用本文: 侯宇颖, 张彩云, 云荣荣, 田金徽, 张志刚, 岳伟岗, 蒋由飞. 头罩式无创正压通气对成人急性呼吸衰竭疗效的 Meta 分析. 中国循证医学杂志, 2017, 17(11): 1283-1290. doi: 10.7507/1672-2531.201705018 复制

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