经鼻高流量氧疗对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者有效性及安全性的Meta分析  

Meta-analysis of the efficacy and safety of initial high-flow nasal oxygen therapy in patients with chronic obstructive pulmonary disease

作　　者：程诺 赵月[1] 王爱平[1] Cheng Nuo;Zhao Yue;Wang Aiping(Nursing Department of the first Hospital Affiliated to china Medical University Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院护理部,沈阳110001

出　　处：《中国实用护理杂志》2020年第35期2794-2800,F0003,共8页Chinese Journal of Practical Nursing

摘　　要：目的采用Meta分析方法探讨经鼻高流量氧疗与无创正压通气对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者初始治疗患者的有效性及安全性。方法计算机检索Cochrane临床试验数据库、EMBASE、CINAHL、PubMed、web of science、万方、维普及知网数据库,检索时限为建库至2020年3月。由2名研究者按照纳入和排除标准独立筛选文献,评价文献质量并提取数据,有效性指标包括PaCO2值、PaO2值、气管插管率、住院时间、病死率;安全性指标为面部压力性损伤发生率、舒适度。采用RevMan5.3软件进行Meta分析。结果最终纳入7篇文献。其中,英文文献2篇,中文文献5篇,共569例患者。Meta结果显示,经鼻高流量氧疗与无创通气相比,在降低PaCO2方面有明显优势[MD=-1.87,95%CI(-3.42^-0.32),Z=2.37,P=0.02],在减少面部压力性损伤发生率方面有明显优势[OR=0.14,95%CI(0.05~0.39),Z=3.73,P=0.0002];经鼻高流量氧疗组与无创通气组相比,在PaO2、插管率、住院时间、病死率方面差异无统计学意义;在舒适度方面,经鼻高流量氧疗能提高患者的舒适度。结论经鼻高流量氧疗可以降低PaCO2,减少面部压力性损伤的发生,提高舒适度,对住院时间、插管率和病死率方面的影响仍需进一步研究。经鼻高流量氧疗或可替代无创正压通气用于治疗慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者。Objective To systematically evaluate the efficacy and safely of high-flow nasal cannula oxygen therapy in patients with non-extubation lreatment of acute exacerbation chronie obstructive pulmonary disease with type Ⅱ respiratory failure.Methods Computerized Cochrane clinical trial database,EMBASE,CINAHL,PubMed,web of science,Wanfang,VIP and CNKl up to March.2020.Two researchers independently screened the literature according to the inclusion and exclusion criteria,evaluated the quality of literatures and extracted the datas.Meta-analysis was performed using RevMan5.3 software.Results Twelve articles were finally included.Among them,there were 2 English literature and 5 Chinese literatures,totaling 569 patients.Meta results show that in terms of reducing PaCO2,high flow nasal cannula oxygen therapy have obvious advantages com paring with non-invasive ventilation[MD=-1.87,95%C1(-3.42,-0.32),Z=2.37,P=0.02].Incidence of Nasal facial skin breakdown,high flow nasal cannula oxygen therapy aslo have obvious advantages[OR=0.14,95%CI(0.05,0.39),Z=3.73,P=0.0002].In terms of PaO,intubation rate、length of hospital stay、mortality,there was no significant difference between high flow nasal cannula oxygen therapy and non-invasive ventilation.In terms of comfort,high flow nasal cannula oxygen therapy can improve comfort.Conclusion In general,high flownasal cannula oxygen therapy can reduce PaCO,reduce incidence of Nasal facial skin breakdown and improve comfort,but it cannot reduce intubation rate,length of hospital stay and mortality.Subgroups showed that compared with conventional oxygen therapy,high flow nasal cannula oxygen therapy can improve oxygenation and reduce the length of hospital stay,but there is no significant difference between high flow nasal cannula oxygen therapy and non-invasive ventilation.Nasal high-flow oxygen therapy may replace non-invasive ventilation for the trealment of patients with acute exacerbations of chronic obstructive pulmonary disease with type Ⅱ respiratory failure.

关 键 词：经鼻高流量氧疗 无创通气 慢性阻塞性肺疾病 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]