不同无创正压通气模式对我国COPD合并OSAHS患者疗效的Meta分析  

The Efficacy of Different Non-Invasive Positive Pressure Ventilation Patterns on the Treatment of COPD Combined with OSAHS in China:A Meta Analysis

作　　者：刘茜 曹钰洁 王登本 李阳[1,2] 高颖 刘美芳 李建英 LIU Xi;CAO Yu-jie;WANG Deng-ben;LI Yang;GAO Ying;LIU Mei-fang;LI Jian-ying(Xi'an Central Hospital,Shaanxi,Xi'an710003;Graduate Student of Medical School of Yan'an University in 2021,Shaanxi,Yan'an716000;Graduate Student of Medical School of Yan'an University in 2020,Shaanxi,Yan'an716000;Graduate Student of Medical School of Yan'an University in 2019,Shaanxi,Yan'an716000)

机构地区：[1]陕西省西安市中心医院,西安710003 [2]延安大学医学院,陕西延安716000

出　　处：《实用中西医结合临床》2022年第6期1-6,26,共7页Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine

基　　金：陕西省西安市科技计划项目(编号:2019115713YX012SF045);陕西省重点研发计划项目(编号:2019SF-020);陕西省西安市科技计划项目[编号:20200001YX001(1)]。

摘　　要：目的:采用Meta分析评价双相气道正压通气(BiPAP)与持续气道正压通气(CPAP)对我国慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的成效。方法:通过计算机检索中国知网(CNKI)、万方医学数据库、维普中文科技期刊数据库(VIP)等中文数据库,检索时间从建库至2022年1月,提取相应资料后采用RevMan5.4软件、Stata15.0软件进行Meta分析。结果:最终纳入11篇中文文献,800例患者。Meta分析结果显示:BiPAP较CPAP能更好地改善动脉血pH(MD=0.08,95%CI:0.06~0.10,P<0.00001),增加患者的动脉氧分压(MD=5.56,95%CI:2.04~9.08,P=0.002),降低动脉二氧化碳分压(MD=-6.72,95%CI:-9.99~-3.46,P<0.0001),提高夜间最低氧饱和度(MD=2.46,95%CI:1.24~3.68,P<0.0001),改善睡眠呼吸暂停低通气指数(MD=-4.14,95%CI:-6.35~-1.92,P=0.0003),缩短最长呼吸暂停时间(MD=-5.59,95%CI:-7.85~-3.32,P<0.00001)。纳入的11篇文章中,有3篇介绍了治疗的相关不良反应及死亡病例,BiPAP组腹胀4例、口鼻咽干燥4例、气胸3例、死亡病例1例,分别低于CPAP组的腹胀8例、口鼻咽干燥9例、气胸7例、死亡病例16例,差异有统计学意义。结论:相较于CPAP,BiPAP更利于缓解人群重叠综合征导致的呼吸窘迫,可显著改善动脉血气各指标、睡眠呼吸暂停低通气指数、夜间最低氧饱和度和最长呼吸暂停时间,除此之外,BiPAP组死亡病例及不良反应均比CPAP组少,证实了CPAP治疗的安全性与有效性。Objective:To evaluate the efficacy of Bi-level positive airway pressure(BiPAP)and continuous positive airway pressure(CPAP)on the group of chronic obstructive pulmonary disease(COPD)combined with obstructive sleep apnea hypoventilation syndrome(OSAHS)in china using Meta-analysis.Methods:Chinese knowledge resources database(CNKI),Wanfang medical network database,Weip chinese science and technology journal database(VIP)and other chinese databases were searched by computer,from database construction to January 2022.After extracting the corresponding data,Meta-analysis was analyzed using RevMan5.4 software and Stata15.0 software.Results:11 Chinese publications with 800 patients were finally included.The Meta-analysis showed that BiPAP improved the arterial blood pH better than CPAP(MD=0.08,95%CI:0.06~0.10,P<0.00001),increase the arterial oxygen partial pressure in the patient(MD=5.56,95%CI:2.04~9.08,P=0.002),reduce the arterial carbon dioxide partial pressure(MD=-6.72,95%CI:-9.99~-3.46,P<0.0001),improve the SpO_(2) Low(MD=2.46,95%CI:1.24~3.68,P<0.0001),improve AHI(MD=-4.14,95%CI:-6.35~-1.92,P=0.0003),reduce the maximum apnea time(MD=-5.59,95%CI:-7.85~-3.32,P<0.00001).Among the 11 articles included,3 introduced the adverse reactions and deaths related to treatment,4 cases of abdominal distension,4 cases of dry nasopharyngeal,3 cases of pneumothorax,and 1 case of death in the BiPAP group,which were lower than 8 cases of abdominal distension,9 cases of dry nasopharyngeal,7 cases of pneumothorax,and 16 cases of death in the CPAP group,respectively,with statistically significant differences.Conclusion:Compared with CPAP,BiPAP was better able to relieve respiratory distress in patients with the overlapping syndrome in the Chinese population,and significantly improved the arterial blood gas index,AHI,SpO_(2) Low and the longest apnea time.In addition,its deaths and adverse effects were lower than those in the CPAP group,confirming its safety and effectiveness.

关 键 词：慢性阻塞性肺疾病 阻塞性睡眠呼吸暂停低通气综合征 双相气道正压通气 持续气道正压通气 

分 类 号：R563[医药卫生—呼吸系统]