心脏外科手术后低氧血症患者不同氧疗方式疗效的meta分析  

Meta-analysis of the efficacy of different oxygen therapies in patients with hypoxemia after cardiac surgery

作　　者：王园园[1] 焦永宁 王东昌[1] 柳磊[2] 陈刚[1] Wang Yuanyuan;Jiao Yongning;Wang Dongchang;Liu Lei;Chen Gang(The First Department of Respiratory Medicine,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Cardiac Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院呼吸一科,石家庄050051 [2]河北医科大学第三医院心脏外科,石家庄050051

出　　处：《国际呼吸杂志》2023年第6期697-703,共7页International Journal of Respiration

基　　金：河北省医学科学研究重点课题计划(20180467)。

摘　　要：目的通过与无创正压通气对比,评价高流量氧疗治疗心脏外科手术后低氧血症的可行性及有效性。方法检索从2000年1月到2023年3月的文献资料,包括检索Pubmed、Medline、Embase数据库、中国知网、中华医学期刊全文数据库、万方数据库、Corchrane图书馆及二次资源。结果共纳入11项试验,共计2107例患者。Meta分析结果显示,高流量氧疗组较无创正压通气组在再插管率(OR=0.37,95%CI:0.25~0.53)方面降低,差异有统计学意义(Z=5.35,P<0.01),2组间的病死率(OR=1.08,95%CI:0.68~1.74),治疗失败率(OR=0.96,95%CI:0.73~1.28)以及ICU住院时间(OR=0.08,95%CI:-0.04~0.20)方面差异均无统计学意义(Z值分别为0.33、0.25、1.28,均P>0.05)。结论高流量氧疗与无创正压通气相比,在再插管率上高流量氧疗具有一定优势;在病死率、治疗失败及住院时间上没有明显的差异,推测心脏外科术后低氧血症患者使用高流量吸氧可能会成为一种新的可行的选择。Objective To evaluate the feasibility and effectiveness of high flow nasal oxygen therapy in the treatment of hypoxemia after cardiac surgery by comparing with non-invasive positive pressure ventilation.Methods The literatures from January 2000 to March 2023 were searched,including Pubmed,Medline,Embase database,CNKI,China Medical Journal Full-text Database,Wanfang database,Corchrane library,and secondary resources.Results A total of 11 trials involving 2107 patients were included.The results of meta-analysis showed that the reintubation rate in the high-flow oxygen therapy group was lower than that in the non-invasive positive pressure ventilation group(OR=0.37,95%CI:0.25-0.53),and the difference was statistically significant(Z=5.35,P<0.01).The mortality(OR=1.08,95%CI:0.68-1.74),the rate of treatment failure(OR=0.96,95%CI:0.73-1.28),and the length of ICU stay(OR=0.08,95%CI:-0.04-0.20)between the two groups were not statistically significant(Z values were 0.33,0.25,and 1.28,respectively,all P>0.05).Conclusions Compared with non-invasive positive pressure ventilation,high-flow oxygen therapy has certain advantages in reintubation rate.However,there were no significant differences in mortality,treatment failure,and length of hospital stay.The results suggest that the use of high-flow oxygen inhalation may become a new viable option for patients with hypoxemia after cardiac surgery.

关 键 词：低氧 经鼻高流量氧疗 无创正压通气 呼吸支持 心脏手术 

分 类 号：R654.2[医药卫生—外科学]