无创双水平正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性加重并发肺性脑病的Meta分析  

Effect of non-invasive bi-level positive airway pressure ventilation combined with naloxone in the treatment of AECOPD complicated with pulmonary encephalopathy：a meta-analysis

作　　者：戚迪[1] 何靖[1] 叶媛[1] 罗曼[1] 冯龙华[1] 王导新[1] 

机构地区：[1]重庆医科大学附属第二医院呼吸内科,重庆400010

出　　处：《中华行为医学与脑科学杂志》2013年第6期533-536,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：基金项目：国家自然科学基金项目（30971303）

摘　　要：目的 评价无创双水平正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性加重（AECOPD）并发肺性脑病（PE）的效果.方法 计算机检索Pubmed、ISI Web of knowledge、中国生物医学文献数据库、中国知网期刊数据库、万方资源数据库,收集国内外发表的关于BiPAP通气联合纳洛酮治疗AECOPD并发PE的相关文献,并按照纳入标准和排除标准筛选初步入选的随机对照实验（RCT）.进行质量评价后,提取有效数据并利用RevMan 5.2软件进行meta分析.结果 共纳入10篇RCT文献,包括697例患者（试验组353例,对照组343例）,系统评价结果表明：BiPAP联合纳洛酮治疗有助于提高AECOPD合并PE患者的PaO2[WMD =4.10,95％ CI （2.83,5.38）,P＜0.00001]、pH值[WMD =0.04,95％ CI （0.02,0.05）,P＜0.00001]及临床有效率[OR=3.58,95％ CI（2.22,5.76）,P＜0.00001],降低PaCO2[WMD=-5.78,95％CI（-6.87,4.69）,P＜0.00001]、再插管率[OR=0.19,95％ CI （0.11,0.35）,P＜0.00001].但不能有效降低死亡率[OR=0.38,95％ CI（0.11,1.34）,P=0.13].结论 BiPAP联合纳洛酮治疗AECOPD并发PE可以改善患者血气指标,提高临床疗效,降低再插管率,但不能有效降低死亡率.Objective To review the effect of non-invasive bi-level positive airway pressure ventilation combined with naloxone in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with pulmonary encephalopathy （PE）.Methods Related published studies involving BiPAP combined with naloxone in the treatment of AECOPD complicated with PE were recruited and identified from Pubmed,ISI Web of knowledge,CBM Disc,CNKI,Wanfang Data,and randomized controlled trails（RCTs） primarily collected were screened according to inclusive criteria and exclusive criteria.Valid data were extracted after quality evaluation for meta-analysis utilizing RevMan 5.2.Results A total of 10 Chinese RCTs were enrolled,including 697 patients （353 patients in experimental group while 343 patients in control group）.The results of metaanalysis indicated that BiPAP combined with naloxone improved PaO2 （WMD =4.10,95% CI （2.83,5.38）,P〈0.00001）,PH value（WMD =0.04,95% CI （0.02,0.05）,P 〈 0.00001） and clinical efficiency rate （OR =3.58,95 % CI （（2.22,5.76）,P 〈 0.00001）,and reduced PaCO2 （WMD =-5.78,95 % CI （-6.87,4.69）,P 〈 0.00001）,re-endotracheal intubation rate （OR =0.19,95 % CI （0.11,0.35）,P 〈 0.00001）,but failed to decrease mortality（OR =0.38,95% CI （0.11,1.34）,P =0.13） of patients with AECOPD complicated with PE.Conclusions BiPAP combined with naloxone play a protective role in enhancing arterial blood gas indexes,improving clinical efficiency rate and limiting re-endotracheal intubation rate.However,the mortality of patients cannot be reduced.

关 键 词：无创双水平正压通气 纳洛酮 慢性阻塞性肺疾病急性加重 肺性脑病 META分析 

分 类 号：R563.9[医药卫生—呼吸系统]