经鼻高流量氧疗治疗心源性肺水肿疗效的荟萃分析  

High-flow nasal cannula oxygen therapy in patients with cardiogenic pulmonary edema:a meta-analysis

作　　者：季佩宇 谈定玉 朱庆程 凌冰玉 王兵侠 曹鹏 JI Pei-yu;TAN Ding-yu;ZHU Qing-cheng;LING Bing-yu;WANG Bing-xia;CAO Peng(Department of Emergency Medicine,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Northern Jiangsu People's Hospital,Jiangsu Yangzhou,225001,China)

机构地区：[1]扬州大学附属苏北人民医院江苏省苏北人民医院急诊医学科,江苏扬州225001

出　　处：《内科急危重症杂志》2025年第1期32-35,68,共5页Journal of Critical Care In Internal Medicine

基　　金：江苏省卫健委医学研究项目(M2020014);江苏省卫生应急研究所课题(JSWSYJ-20210801);扬州市科技计划项目(YZ2023123)。

摘　　要：目的:评价经鼻高流量氧疗(HFNC)治疗心源性肺水肿的疗效。方法:计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方医学数据库、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、科学网及Cochrane图书馆数据库2023年6月前公开发表的关于HFNC治疗心源性肺水肿的随机对照研究(RCT)。HFNC组采用HFNC,对照组采用传统氧疗(COT)。主要结局指标为气管插管率和28d病死率,次要结局指标包括生命体征、血气分析、左心室射血分数(LVEF)、脑钠肽及ICU住院时间等。结果:共纳入5项RCT,共437例患者,HFNC组217例,对照组220例。荟萃分析结果显示,在降低气管插管率方面,HFNC较COT有明显的优势(OR=0.34,95%CI:0.14~0.83,P=0.02);在28d病死率方面,HFNC优于COT(OR=0.22,95%CI:0.07~0.70,P=0.01)。在不同时刻的呼吸频率、PaO_(2)、LVEF和ICU住院时间方面HFNC均优于COT。在心率、平均动脉压及PaCO_(2)分压方面,HFNC与COT无明显差异。结论:与COT比较,HFNC可以降低心源性肺水肿患者的气管插管率及28d病死率。Objective:To perform a meta-analysis to evaluate the efficacy of high-flow nasal cannula oxygen(HFNC)therapy in patients with cardiogenic pulmonary edema.Method:We performed a comprehensive search of the CNKI,CBM,VIP,Wanfang,PubMed,EMBASE,Web of Science and Cochrane databases,identifying randomized controlled trials(RCTs)that compared HFNC to conventional oxygen therapy(COT).The control group was treated with COT,while the experimental group was treated with HFNC.The primary outcomes included the intubation rate and mortality rate at 28 days,and the second outcomes included the vital signs,arterial blood gas results,left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP),and ICU stays.Results:A total of 5 RCTs were enrolled in this study.There were 437 patients enrolled,217 patients in HFNC group,and 220 in control group.Meta-analysis showed that HFNC had a significant advantage over COT in reducing the tracheal intubation rate[odds ratio(OR)=0.34,95%confidence interval(95%CI)=0.14-0.83,P=0.02]and mortality rate at 28 days(OR=0.22,95%=0.07-0.70,P=0.01).There was a significant difference in respiratory rates,arterial partial pressure of oxygen,LVEF,and ICU stays between COT group and HFNC group.However,there was no significant difference in heart rates,mean arterial pressure,and arterial partial pressure of carbon dioxide.Conclusions:Compared with COT,HFNC could reduce the rate of tracheal intubation and mortality rate at 28 days in patients with cardiogenic pulmonary edema.

关 键 词：心源性肺水肿 心力衰竭 经鼻高流量氧疗 传统氧疗 荟萃分析 

分 类 号：R459.6[医药卫生—治疗学]