患者拔除气管插管后应用经鼻高流量氧疗效果的Meta分析  

Effects of high-flow nasal cannulae in patients after extubation:a meta-analysis

作　　者：李丽莉[1] 代冰[2] 董新新 LI Lili;DAI Bing;DONG Xinxin

机构地区：[1]中国医科大学附属第一医院乳腺外科,沈阳市110001 [2]中国医科大学附属第一医院呼吸内科,沈阳市110001

出　　处：《中华护理杂志》2018年第12期1492-1497,共6页Chinese Journal of Nursing

基　　金：国家自然科学基金(81400061)

摘　　要：目的采用Meta分析方法研究经鼻高流量氧疗在拔除气管插管后患者中应用的效果。方法检索Embase、Cochrane临床试验数据库、PubMed、万方数据库、维普数据库及中国期刊全文数据库中1980年1月—2017年12月发表的有关经鼻高流量氧疗在气管插管拔管后患者序贯应用疗效比较的随机对照试验,并应用Revman 5.3软件进行统计分析。结果最终纳入11篇文献,其中,英文文献10篇,中文文献1篇,共3 183例患者。经鼻高流量氧疗与常规氧疗比较,可以显著降低患者再插管率[OR=0.48,95%CI(0.32,0.72),Z=3.48,P<0.001],提高氧合指数[MD=55.12,95%CI(35.58,74.67),Z=5.53,P<0.001),以及提高患者舒适度。与无创正压通气比较,经鼻高流量氧疗对患者再插管率无显著影响[OR=1.13,95%CI(0.86,1.49),Z=0.87,P=0.38]。分别与常规氧疗和无创正压通气比较,经鼻高流量氧疗对患者ICU病死率无显著影响[OR=0.99,95%CI(0.51,1.93),Z=0.02,P=0.98][OR=1.20,95%CI(0.78,1.85),Z=0.83,P=0.40];对ICU住院时间也无显著影响[SMD=0.05,95%CI (-0.05,0.15),Z=1.06,P=0.29][SMD=-0.02,95%CI(-0.12,0.09),Z=0.29,P=0.77]。结论经鼻高流量氧疗与常规氧疗比较,可以显著改善患者氧合,降低再插管率,提高患者舒适度,但并不能降低患者的ICU病死率和缩短ICU住院时间。Objective To evaluate the effects of high-flow nasal cannLdae (HFNC)in patients after extubation by using meta-analysis.Methods An extensive search of related literature from EMBASE,Cochrane Library,PubMed, Wanfang Database,VIP database and CNKI from January 1980to December 2017was performed.Randomized con- trolled trials(RCTs)comparing the effects of high-flow nasal eannulae in patients with tracheal intubation after extubation were collected.Meta-analysis was performed by RevMan 5.3.Results Eleven studies were final]y included, with 10English articles and 1Chinese and a total of 3183patients.Comparing with conventional oxygen therapy (COT),HFNC significantly reduced patients'reintubation rate [0R=0.48,95%CI (0.32,0.72),Z=3.48,P<0.001]and increased oxygenation index [MD=55.12,95%CI (35.58,74.67),Z=5.53,P<0.001],and improved patient comfort.Com- paring with non-invasive positive pressure ventilation (NPPV),HFNC had no significant effect on reintubation rate [0R=1.13,95%CI (0.86,1.49),Z=0.87,P=0.38].Comparing with COT and NPPV separately,HFNC had no significant effect on ICU mortality [OR=0.99,95%CI(0.51,1.93),Z=0.02,P=O.98][OR=l.20,95%CI(0.78,1.85),Z=0.83, P=-0.40],and length of ICU stay [SMD=0.05,95%CI(-0.05,0.15),Z=1.06,P=0.29][SMD=-0.02,95%CI(-0.12,0.09), Z=0.29,P=0.77].Conclusion Compared with COT,HFNC can significantly improve patients'oxygenation,reduce reintubation rate,and improve patient comfort,but it cannot reduce ICU mortality and length of ICU stay.

关 键 词：经鼻高流量氧疗 常规氧疗 无创正压通气 META分析 

分 类 号：R473[医药卫生—护理学]