经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析  

Meta-analysis of efficacy of high-flow nasal cannula oxygen therapy during endotracheal intubation in critically ill patients

作　　者：李海亮 俞云[1] 张星星 陈管洁 刘玲[1] 谢剑锋[1] 常炜 Li Hailiang;Yu Yun;Zhang Xingxing;Chen Guanjie;Liu Ling;Xie Jianfeng;Chang Wei(Jiangsu Provincial Key Laboratory of Critical Care Medicine,Department of Critical Care Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China)

机构地区：[1]江苏省重症医学重点实验室,东南大学附属中大医院重症医学科,南京210009

出　　处：《中华重症医学电子杂志》2024年第3期227-235,共9页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：东南大学附属中大医院护理科研立项课题(KJZC-HL-202008)

摘　　要：目的探讨经鼻高流量氧疗(HFNC)在危重症患者气管插管过程中呼吸暂停期间持续应用的效果。方法检索中国知网、维普、万方、PubMed、Cochrane Library及Embase中关于危重症患者气管插管过程中应用HFNC效果的随机对照试验(RCT)研究,检索时限为建库至2023年7月30日。由2名研究者独立进行文献筛选、资料提取和质量评价,采用RevMan5.4软件进行统计分析。结果纳入英文文献6篇,共计855例患者。荟萃分析结果显示,相较于常规组,HFNC组在气管插管过程中可以维持更高的血氧饱和度(SpO_(2))(%,MD:84,95%CI:0~1.68,P=0.05),ICU住院时间明显缩短(d,MD:1.8,95%CI:0.84~2.76,P=0.0002);2组SpO_(2)<80%发生率(OR=0.88,95%CI:0.62~1.25,P=0.49)、气管插管相关并发症发生率(OR=0.72,95%CI:0.52~1.01,P=0.06)、28 d病死率(OR=0.76,95%CI:0.55~1.05,P=0.10)比较,差异均无统计学意义。结论气管插管过程中持续使用HFNC能维持更高的SpO_(2),并且与ICU住院时间缩短密切相关,但临床还需要更多的研究来明确HFNC维持呼吸暂停氧合对气管插管危重症患者的益处。Objective To investigate the efficacy of high-flow nasal cannula oxygen(HFNC)during endotracheal intubation in critically ill patients.Methods Database including CNKI,VIP,Wanfang,PubMed,Cochrane Library,and Embase for randomized controlled studies on the eff icacy of continuous HFNC therapy during endotracheal intubation in critically ill patients was searched from inception to July 30,2023.Literature screening,data extraction,and quality evaluation were independently performed by two investigators to enable statistical analysis using RevMan 5.4 software.Results The results of our meta-analysis showed that compared with conventional therapy,HFNC could maintain a higher pulse oxygen saturation(SpO_(2))during endotracheal intubation(%,MD=84,95%CI:0~1.68,P=0.05),and futher a significantly shorter ICU stay(d,MD=1.8,95%CI:0.84~2.76,P=0.0002);there was no significant difference in the incidence of SpO_(2)<80%(OR=0.88,95%Cl:0.62-1.25,P=0.49),the incidence of endotracheal intubation-related complications(OR=0.72,95%Cl:0.52-1.01,P=0.06),and 28-day mortality(OR=0.76,95%Cl:0.55-1.05,P=0.10)between the two groups.Conclusion Continuous use of HFNC during endotracheal intubation can maintain higher SpO_(2)and is closely related to shortened ICU stay,but more clinical studies are needed to clarify the benefits of HFNC to maintain apnoeic oxygenation in critically ill patients during endotracheal intubation.

关 键 词：经鼻高流量氧疗 气管插管 呼吸暂停 荟萃分析 

分 类 号：R459.7[医药卫生—急诊医学]