经鼻高流量氧疗对急性呼吸衰竭患者疗效的meta分析  

Meta-analysis of the effect of high-flow nasal cannula oxygen therapy on patients with acute respiratory failure

作　　者：王营营 米元元 吴赞芳[1] 郑兰平 Wang Yingying;Mi Yuanyuan;Wu Zanfang;Zheng Lanping(Emergency department,Yijishan hospital of Wannan Medical College,Wuhu,Anhui,241001,China;Department of critical care medicine,Union hospital,Tongji Medical school of Huazhong University of Science and Technology;Department of nursing,the cancer hospital of Fudan University,Shanghai,200000,China)

机构地区：[1]皖南医学院弋矶山医院急诊抢救室,安徽芜湖241001 [2]华中科技大学同济医学院附属协和医院重症医学科,湖北武汉430022 [3]复旦大学附属肿瘤医院护理部,上海200000

出　　处：《齐齐哈尔医学院学报》2022年第16期1523-1529,共7页Journal of Qiqihar Medical University

基　　金：安徽省省级质量工程项目(2020wyxm185);皖南医学院教学质量与教学改革工程项目(2021jyxm27);安徽省人文社会科学重点研究基地开放基金项目(SJD202003)。

摘　　要：目的采用meta分析的方法评价经鼻高流量氧疗在急性呼吸衰竭患者中的有效性。方法系统检索PubMed、Embase、Web of Science、Cochrane临床试验数据库、CINAHL数据库、CNKI、万方数据库、维普数据库及中国生物医学数据库2020年4月1日以前公开发表的有关经鼻高流量氧疗在急性呼吸衰竭患者应用疗效的随机对照实验,实验组采用经鼻高流量氧疗(HFNC组),对照组采用常规氧疗(常规氧疗组)或者无创通气(无创通气组),结局指标为再插管率、住院时间、28天病死率、90天病死率、ICU死亡率、呼吸频率、氧合指数以及ICU获得性感染等。由2名研究员独立进行文献筛选、评价及数据提取后,采用Revman5.3软件对纳入文献进行meta分析。结果共纳入9篇文献;共3427例患者,其中HFNC组1605例,对照组1822例(其中无创通气组784例、常规氧疗组1038例)。与常规氧疗组相比,HFNC组具有较低的插管率[OR=0.70,95%CI(0.57,0.86),Z=3.38,P=0.0007]和90天病死率[OR=0.47,95%CI(0.24,0.90),Z=2.27,P=0.02],而在住院时间、28天病死率、ICU病死率、住院病死率和ICU获得性感染方面则无显著影响[MD=-2.25,95%CI(-4.84,0.35),Z=1.70,P=0.09][OR=0.96,95%CI(0,74,1.26),Z=0.27,P=0.78][OR=0.92,95%CI(0.70,1.21),Z=0.56,P=0.57][OR=0.95,95%CI(0.73,1.25),Z=0.35,P=0.73][OR=0.77,95%CI(0.55,1.10),Z=1.43,P=0.15];与无创通气组相比,HFNC组具有较低的插管率[OR=0.60,95%CI(0.41,0.90),Z=2.50,P=0.01]、90天病死率[OR=0.32,95%CI(0.17,0.59),Z=3.60,P=0.0003]、ICU死亡率[OR=0.35,95%CI(0.20,0.63),Z=3.50,P=0.0005]和呼吸频率[MD=-1.34,95%CI(-2.15,-0.54),Z=3.26,P=0.001],而且在改善氧合指数方面,无创通气组优于经鼻高流量氧疗组[MD=-36.95,95%CI(-38.56,-35.35),Z=45.12,P<0.00001],但对于住院时间无显著差异[MD=-0.45,95%CI(-2.16,1.26),Z=0.51,P=0.61]。结论与常规氧疗和无创通气相比,HFNC能降低急性呼吸衰竭患者的插管率和90天的病死率,但并不能缩短ICU住院时间。Objective To evaluate the efficacy of high-flow nasal cannula oxygen therapy in patients with acute respiratory failure by meta-analysis.Methods We searched in data bases of PubMed,Embase,web of science,Cochrane clinical trial database,CINAHL database,CNKI,Wanfang database,VIP database and Chinese biomedical database for randomized controlled trial on the efficacy of high-flow nasal cannula oxygen therapy in patients with acute respiratory failure those were published before April 1,2020.The experimental group received high-flow nasal cannula oxygen therapy(HFNC group),while the control group received conventional oxygen therapy(conventional oxygen therapy group)or non-invasive ventilation(non-invasive ventilation group).The outcome indicators were reintubation rate,length of hospital stay,28-day mortality,90-day mortality,ICU mortality,respiratory frequency,oxygenation index,and ICU acquired infection.After literature screening,evaluation and data extraction were independently conducted by two researchers,meta-analysis was performed on the included literature by Revman5.3 software.Results The study enrolled 9 literatures,including a total of 3427 patients,1605 in HFNC group and 1822 in control group were included(784 cases in the non-invasive group and 1038 cases in the conventional oxygen therapy group).Compared with conventional oxygen therapy,HFNC significantly reduces intubation rate[OR=0.70,95%CI(0.57,0.86),Z=3.38,P=0.0007]and 90-day mortality[OR=0.47,95%CI(0.24,0.90),Z=2.27,P=0.02];There were nosignificant effect on length of stay,28-day mortality,ICU mortality,in-hospital mortality and acquired infection in ICU between the two groups[MD=-2.25,95%CI(-4.84,0.35);Z=1.70,P=0.09][OR=0.96,95%CI(0,74,1.26);Z=0.27,P=0.78][OR=0.92,95%CI(0.70,1.21);Z=0.56,P=0.57][OR=0.95,95%CI(0.73,1.25);Z=0.35,P=0.73][OR=0.77,95%CI(0.55,1.10);Z=1.43,P=0.15].Compared with non-invasive ventilation,HFNC significantly reduced intubation rate[OR=0.60,95%CI(0.41,0.90);Z=2.50,P=0.01]and 90-day mortality[OR=0.32,95%CI(0.17,0.59);Z=3.60,P=

关 键 词：经鼻高流量氧疗 无创正压通气 常规氧疗 急性呼吸衰竭 META分析 

分 类 号：R459.6[医药卫生—治疗学]