经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭患者临床疗效的Meta分析  

Clinical Effect of Humidified High Flow Nasal Cannula in the Treatment of Patients with Chronic Obstructive Pulmonary Disease Combined with Type Ⅱ Respiratory Failure:a Meta-analysis

作　　者：姜琪娜[1] 于健健 王珺[1] 李士涛[1] 蔡成森[1] JIANG Qina;YU Jianjian;WANG Jun;LI Shitao;CAI Chengsen(Department of Respiration,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China)

机构地区：[1]山东中医药大学第二附属医院呼吸科,山东省济南市250001

出　　处：《实用心脑肺血管病杂志》2020年第11期71-76,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：山东省中医药科技发展计划项目(2017-120,2019-0217);中国宋庆龄基金会呼吸疾病临床公益基金慢阻肺专项(2018MZFS-034)。

摘　　要：背景经鼻高流量湿化氧疗(HFNC)是一种新型无创氧疗方式,可提供低水平持续气道正压,且患者耐受性较好,但目前其治疗慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭患者临床疗效的研究报道仍较少。目的系统评价HFNC治疗COPD并Ⅱ型呼吸衰竭患者的临床疗效,以期为COPD并Ⅱ型呼吸衰竭患者选择氧疗方式提供循证证据。方法计算机检索维普网(VIP)、万方数据知识服务平台、中国知网(CNKI)及Springer、Cochrane Library、PubMed数据库,获取已公开发表的HFNC治疗COPD并Ⅱ型呼吸衰竭患者临床疗效的随机对照试验(RCT),检索时间自建库至2019-12-31。试验组患者给予基础治疗+HFNC,对照组患者给予基础治疗+无创正压通气(NIPPV)或鼻导管低流量氧疗。比较两组患者治疗后心率、呼吸频率、动脉血氧分压(PaO2)、动脉血二氧化氮分压(PaCO2)及治疗期间气管插管率、治疗期间病死率、治疗期间不良反应发生率、住院天数。采用RevMan 5.3软件进行Meta分析。结果共纳入7篇文献(文献质量评价分级均为B级),包括475例患者,其中试验组240例、对照组235例。Meta分析结果显示,试验组患者治疗后心率〔MD=-4.29,95%CI(-7.09,-1.49)〕、呼吸频率〔MD=-2.51,95%CI(-4.41,-0.60)〕及治疗期间不良反应发生率〔OR=0.08,95%CI(0.04,0.16)〕低于对照组(P<0.05)。两组患者治疗后PaO2〔MD=4.29,95%CI(0.08,8.50)〕、PaCO2〔MD=-2.47,95%CI(-5.92,0.99)〕及治疗期间气管插管率〔OR=0.41,95%CI(0.16,1.04)〕、治疗期间病死率〔OR=0.70,95%CI(0.25,1.94)〕、住院天数〔MD=-0.32,95%CI(-2.10,1.46)〕比较,差异无统计学意义(P>0.05)。结论HFNC能有效降低COPD并Ⅱ型呼吸衰竭患者心率、呼吸频率,且不良反应较少,安全性较高。Background Humidified high flow nasal cannula(HFNC)is a new type of non-invasive oxygen therapy,which can provide low level of continuous positive airway pressure,and is well tolerated by patients.However,there are few reports on the clinical effect of HFNC on chronic obstructive pulmonary disease(COPD)combined with type Ⅱ respiratory failure.Objective To systematically evaluate the clinical effect of HFNC in the treatment of patients with COPD combined with type Ⅱ respiratory failure,in order to provide evidence-based evidence for the selection of oxygen therapy for patients with COPD combined with typeⅡrespiratory failure.Methods Databases of VIP,Wanfang Data,CNKI,Springer,Cochrane Library and PubMed were searched for randomized controlled trials(RCTs)about clinical effect of HFNC in the treatment of patients with COPD combined with type Ⅱ respiratory failure from inception to December 31,2019.Patients in the experimental group were given basic treatment+HFNC,while patients in the control group were given basic treatment+noninvasive positive pressure ventilation(NIPPV)or nasal catheter low flow oxygen therapy.The heart rate,respiratory rate,PaO2,PaCO2 after treatment and tracheal intubation rate,mortality,incidence of adverse reactions during treatment,length of stay were compared between the two groups.Meta-analysis was conducted by using RevMan 5.3.Results A total of 7 literatures(all of literatures with grade B)were enrolled and 475 cases were involved(240 cases in experimental group and 235 cases in control group).Meta-analysis results showed that,heart rate after treatment〔MD=-4.29,95%CI(-7.09,-1.49)〕,respiratory rate after treatment〔MD=-2.51,95%CI(-4.41,-0.60)〕,and incidence of adverse reactions during treatment〔OR=0.08,95%CI(0.04,0.16)〕in the experimental group were lower than those in the control group(P<0.05).There were no significant differences in PaO2 after treatment〔MD=4.29,95%CI(0.08,8.50)〕,PaCO2 after treatment〔MD=-2.47,95%CI(-5.92,0.99)〕,tracheal intubation rate durin

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 经鼻高流量湿化氧疗 治疗结果 随机对照试验 META分析 

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