经鼻高流量氧疗用于拔管后患者疗效的系统评价再评价  

The efficacy of high-flow nasal cannula oxygen therapy for patients after extubation: an overview of systematic reviews

作　　者：刘琴[1,2] 谢湘梅 骆佳佳[1,2] 焦凡 胡晓莹 LIU Qin;XIE Xiang-mei;LUO Jia-jia;JIAO Fan;HU Xiao-ying(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330006,China;不详)

机构地区：[1]南昌大学第二附属医院呼吸与危重症医学科,江西南昌330006 [2]南昌大学研究生院,江西南昌330006 [3]南昌大学第二附属医院护理部

出　　处：《中华全科医学》2021年第6期1029-1034,共6页Chinese Journal of General Practice

基　　金：江西省科技厅重点研发计划项目(20171BBG70019,20192BBG70013)。

摘　　要：目的通过检索经鼻高流量氧疗应用于拔管后患者的相关系统评价或meta分析,对纳入研究的方法学质量和证据等级进行评价,以获得最佳证据,从而比较高流量氧疗与其他方式在拔管后患者中的有效性和安全性,以期为经鼻高流量氧疗在危重患者未来的研究重点提供参考。方法计算机检索The Cochrane Library、PubMed、Medline、CNKI、CBM、WANFANG和VIP数据库中关于经鼻高流量氧疗应用于拔管后患者的系统评价或meta分析,检索时间限定为从建库至2020年2月,由2名研究员对文献独立筛选和提取数据,采用AMSTAR 2量表和GRADE系统对纳入文献进行方法学质量和证据质量等级评价。结果共纳入11篇系统评价/meta分析,8篇文章将高流量氧疗分别与无创正压通气、传统氧疗进行对比,3篇文章仅比较了高流量氧疗与传统氧疗的疗效差异。AMSTAR 2评价结果显示,1篇研究方法学质量为低,10篇为极低;GRADE评价结果显示,78个结局指标中,6个为高级质量,37个为中级质量,29个为低级质量,6个为极低质量。大部分研究显示,经鼻高流量氧疗用于拔管患者的再插管率低于传统氧疗,与无创正压通气相似。结论经鼻高流量氧疗可以降低拔管后患者的再插管率,在一定条件下可以作为无创正压通气的替代,但纳入研究的方法学质量偏低,证据质量等级一般,建议开展更高质量的研究,探索高流量氧疗在危重患者中的应用。Objective The aim of this paper was to evaluate the methodological quality and of evidence level for the best evidence, to compare the efficacy and safety of high-flow oxygen therapy with other therapy methods in patients after extubation, and provide reference for the future research priorities of high-flow oxygen therapy in critically ill patients through retrieving systematic review or meta-analysis of patients who were treated with high-flow nasal cannula oxygen therapy after extubation. Methods The Cochrane Library, PubMed, Medline, CNKI, CBM, WANFANG and VIP databases were electronically searched to collect systematic reviews or meta-analysis on the application of high-flow nasal cannula oxygen therapy for the patients after extubation. The retrieval time is limited to February 2020 from the time of database construction. Two researchers independently screened literature, and extracted data AMSTAR 2 scale and GRADE system were used to evaluate the methodological quality and evidence quality of the included literature. Results A total of 11 systematic reviews/meta-analyses were included. Eight articles compared high-flow oxygen therapy with non-invasive positive pressure ventilation and traditional oxygen therapy, and three articles compared the efficacy of high-flow oxygen therapy with traditional oxygen therapy only. The methodological quality evaluation by AMSTAR 2 was generally low, one study was low and 10 was extremely low. GRADE evaluation results showed that among the 78 evidence level outcome, 6 were high quality, 37 were intermediate quality, 29 were low quality and 6 were extremely low quality. Most studies have shown that the rate of re-intubation in patients with extubation using nasal high-flow oxygen therapy is lower than that of traditional oxygen therapy and similar to non-invasive positive pressure ventilation. Conclusion High-flow nasal cannula oxygen therapy can reduce the reintubation rate of patients after extubation and can be used as an alternative to non-invasive positive pressure ve

关 键 词：经鼻高流量氧疗 无创通气 气管插管拔除 系统评价再评价 

分 类 号：R459.6[医药卫生—治疗学]