无创正压通气对急性呼吸衰竭患者拔管后再插管率和预后影响的荟萃分析  

Effects of noninvasive positive pressure ventilation on mortality and rate of reintubation in mechanical ventilation patients after extubation： a meta-analysis

作　　者：郭凤梅[1] 刘松桥[1] 杨从山[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科,南京210009

出　　处：《中华急诊医学杂志》2011年第4期360-365,共6页Chinese Journal of Emergency Medicine

基　　金：江苏省自然科学基金（BK2008298）;江苏省“科教兴卫工程”医学领军人才基金（2007）

摘　　要：目的 探讨无创正压通气对急性呼吸衰竭患者拔管后再插管率和预后的影响.方法 通过计算机检索和手工检索中文期刊数据库,Pubmed,Embase,Web of Science数据库,收集1995年1月1日至2010年6月30日关于无创正压通气对急性呼吸衰竭患者拔管后进行呼吸支持和治疗的随机对照研究,按Cochrane协作网推荐的方法对拔管后采用无创正压通气进行呼吸辅助治疗患者的再插管率和病死率行Meta评价.结果 共纳入6篇随机对照研究,其中拔管后无创正压通气组（治疗组）患者381例,拔管后常规氧疗组（对照组）患者379例,治疗组和对照组患者的病死率分别为18.6%（62/334）vs.21.6%（72/333）（P=0.34）,再插管率分别为30.2%（115/381）vs.33.5%（127/379）（P=0.27）.与常规氧疗相比,拔管后无创正压通气不能降低患者再插管率,也不能改善患者预后.对拔管后即开始进行无创正压通气的患者进行分析,结果提示治疗组患者病死率明显降低[12.2%（22/181）vs.23.9%（44/184）,P=0.004],再插管率减少;但与对照组相比,差异无统计学意义[14.0%（32/228）vs.20.4%（47/230）,P=0.07].结论 急性呼吸衰竭患者拔管后早期行无创正压通气有助于减少患者再插管率,可显著改善患者预后.Objective To evaluate the effects of noninvasive positive pressure ventilation （NPPV）used after extubation on mortality and rate of reintubation in patients with acute respiratory failure （ARF）.Method Pubmed, Embase, Web of Science databases were searched to collect data from randomized controlled trials （RCT） of the relevant subject from January 1995 to May 2010. Meta analysis of data about NPPV on mortality and rate of reintubation in patients after extubation carried out by using the methods recommended by the Cochrane Collaboration. Results Six RCTs included sample size of 381 NPPV and 379routine medical care. In total, the mortalities of patients in NPPV group and routine medical care group were 18.6% （62/334） vs. 21.6% （72/333）, respectively, and the rates of reintubation of the two groups were 30.2% （115/381） vs. 33.5% （127/379）, respectively. Compared with routine medical care, NPPV did not significantly reduce the mortality （ OR： 0.83, 95% CI =0.57 ～ 1.21 ,P =0.34） and rate of reintuation（ OR： 0.83, 95% CI = 0.59 ～ 1.16, （ P = 0.27）. When the analysis was focused to the four studies of them in which patients received NPPV as soon as extubation, the results were quite different. From these four studies, the mortalities of patients in NPPV group and routine medical care group were 12. 2% （22/181） vs.23.9% （44/184）,（P=0.004）, and the rate of reintubation of the two groups were 14.0% （32/228） vs.20.4% （47/230）, （P =0.07）. Compared with routine medical care, early application of NPPV to patients after extubation reduced the mortality. Conclusions This study suggests the favorable effects of early application of NPPV to patients after extubation on the mortality of acute respiratory failure.

关 键 词：无创正压通气 急性呼吸衰竭 病死率 荟萃分析 

分 类 号：R563.8[医药卫生—呼吸系统]