无创通气用于肺性脑病患者疗效的Meta分析  

Effect of noninvasive ventilation on hypercapnic encephalopathy syndrome： a Meta-analysis

作　　者：刘奇[1] 陈荣昌[2] 贾留群[1] 程哲[1] 

机构地区：[1]郑州大学第一附属医院呼吸与重症科河南省高等学校临床医学重点学科开放实验室,河南郑州450052 [2]呼吸疾病国家临床研究中心,广州呼吸疾病研究所,呼吸疾病国家重点实验室,广州医科大学第一附属医院,广东广州510120

出　　处：《中华危重病急救医学》2016年第1期57-62,共6页Chinese Critical Care Medicine

基　　金：国家自然科学青年基金（81400051）

摘　　要：目的系统评价无创通气（NIV）对慢性阻塞性肺疾病急性加重期（AECOPD）等所致高碳酸血症性呼吸衰竭（呼衰）引起肺性脑病（HES）患者的疗效。方法计算机检索美国国立医学图书馆PubMed、荷兰医学文摘EMBASE、Cochrane临床试验数据库、中国期刊网全文数据库、万方数据库，从建库起至2015年1月发表的有关NIV与经典有创通气（CMV）用于HES患者疗效比较的随机对照试验（RCT）及病例对照研究，采用严格技术评价项目（CASP）清单进行质量评价，提取病死率、气管插管率、机械通气持续时间、并发症发生率等资料，利用RevMan5．3软件进行荟萃分析（Meta分析）。结果共纳入6篇文献、225例患者，NIV组112例，CMV组113例；Kelly—Matthay昏迷评分均值为3分。与CMV组比较，NIV组可明显降低患者病死率[20．5％（23／112）比32．7％（37／113），相对危险度（RR）=0．63，95％可信区间（95％CI）=0．40。0．98，P=0．04]、气管插管率[35．7％（40／112）比100．0％（113／113），RR=0．38，95％CI=0．26～0．55，P〈0．00001]、机械通气相关并发症发生率[26．2％（21／80）比50．6％（42／83），RR=0．52，95％CI=0．34～0．79，P=0．002]，缩短机械通气时间[d：7．1比16．2，加权均数差（SMD）=-0．93，95％CI=-1．39—-0．46，P=0．0001]。结论在密切监测下NIV可降低AECOPD等所致高碳酸血症性呼衰引起HES患者的总体住院病死率、气管插管率，减少机械通气相关并发症的发生。Objective To evaluate the effect of noninvasive ventilation （NIV） on hypercapnic encephalopathy syndrome （HES） induced by acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods An extensive search of related literature from the PubMed, EMBASE, Cochrane library, CNKI and Wanfang databases up to January 2015 was performed. Randomized controlled trials （RCTs） and case control studies regarding comparison of the effect of NIV and conventional mechanical ventilation （CMV） on the HES were collected. Critical appraisal skills program （CASP） was adopted to assess the quality of the studies. Data including mortality, trachea intubation rate, duration of mechanical ventilation and complication rate were collected, and Meta-analysis was performed by RevMan 5.3. Results Finally, 6 studies were included with 225 subjects, among whom 112 were in NIV group and 113 in CMV group, and the average Kelly-Matthay score was 3. Compared with CMV group, the mortality [20.5% （23/112） vs. 32.7% （37/113）, risk ratio （RR） = 0.63, 95% confidential interval （95%CI） = 0.40-0.98, P = 0.04], intubation rate [35.7% （40/112） vs. 100.0% （113/113）, RR = 0.38, 95%CI = 0.26-0.55, P 〈 0.000 01], incidence of ventilation related complications [26.2% （21/80） vs. 50.6% （42/83）, RR = 0.52, 95%CI = 0.34-0.79, P = 0.002] in NIV group were significantly decreased, and the duration of mechanical ventilation was significantly shortened [days： 7.1 vs. 16.2, standard mean difference （SMD） = -0.93, 95%CI = -1.39 to -0.46, P 〈 0.0001]. Conclusion NIV could significantly lower the mortality rate, intubation rate, and complications in the treatment of HES induced by AECOPD under close monitoring.

关 键 词：无创通气 肺性脑病 肺疾病 阻塞性 慢性 急性加重期 META分析 

分 类 号：R563.9[医药卫生—呼吸系统] R747.9[医药卫生—内科学]