长期无创正压通气治疗重度稳定期慢性阻塞性肺疾病合并呼吸衰竭的效果评价:一项随机对照试验的Meta分析  

The efficacy of noninvasive positive pressure ventilation on severe stable chronic obstructive pulmonary disease with respiratory failure patients:a meta-analysis of randomized controlled trials

作　　者：王梅[1] 廖浩 裴文迪 李虹甫 王凯[1] 陈新[1] WANG Mei;LIAO Hao;PEI Wendi;LI Hongfu;WANG Kai;CHEN Xin(Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P. R. China)

机构地区：[1]南方医科大学珠江医院呼吸内科,广东广州510282

出　　处：《中国呼吸与危重监护杂志》2018年第3期223-229,共7页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广东省医学科学技术研究基金(A2016399)

摘　　要：目的评价长期无创正压通气(NPPV)对重度稳定期慢性阻塞性肺疾病(简称慢阻肺)合并呼吸衰竭患者的病死率、急性加重、活动能力和症状的影响,以及重要的生理学参数(肺功能、呼吸肌肉功能、气体交换)改变。方法检索Pub Med、Cochrane library、Embase、OVID、中国生物医学文献数据库,检索时间至2017年2月。纳入研究均为随机对照试验(RCT),比较NPPV与氧疗在稳定期慢阻肺合并慢性呼吸衰竭患者中的治疗效果,并至少包含一个以下指标:急性加重次数、病死率、肺功能、呼吸肌肉功能、气体交换、6分钟步行试验。结果共纳入6个RCT研究,合计695例患者。与氧疗相比,NPPV能显著降低慢阻肺合并慢性呼吸衰竭患者的Pa CO2[加权均数为–3.23(95%可信区间–5.39~–1.06,P=0.00)],但是对病死率、急性加重次数、PaO_2、肺功能、呼吸肌肉功能以及运动能力无显著影响。亚组分析显示当NPPV以降低高碳酸血症为目标时,能显著减少患者病死率。结论目前证据显示长期NPPV与氧疗相比未能对重度稳定期慢阻肺患者带来额外益处。但是,当NPPV以降低高碳酸血症为目标时能显著降低病死率。Objective To assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters（lung function, respiratory muscle function and gas exchange） of patients with severe stable chronic obstructive pulmonary disease（COPD） with respiratory failure treated by noninvasive positive pressure ventilation（NPPV）. Methods A meta-analysis of randomized controlled trials was carried out by searching Pub Med,Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed： frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test. Results Six studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function,respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia. Conclusion Current evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients＇ mortality with the aim of reducing hypercapnia.

关 键 词：慢性阻塞性肺疾病 META分析 无创正压通气 病死率 急性加重 

分 类 号：R563.8[医药卫生—呼吸系统] R563.9[医药卫生—内科学]