摘要
目的评价高频振荡通气（HFOV）较常规通气（CMV）对成人急性呼吸窘迫综合征（ARDS）患者预后的影响。方法计算机检索Pubmed、Cochrane临床试验数据库、EMBASE、医学文摘、对照试验Meta注册、CBM、CNKI、维普、万方等数据库，并辅以文献追索、手工检索等方法，全面收集关于HFOV治疗成人ARDS的随机对照试验（RCT），按Cochrane协作网提供的RevMan5．2软计进行Meta分析。结果最终纳入符合入选标准的文献7篇，共计478例研究对象，HFOV治疗组246例、CMV治疗组232例。HFOV治疗组和CMV治疗组病死率和并发症发生率分别为[31．3％（77／246）比44．8％（104／232）]和[25．9％（29／112）比25．8％（25／97）]，与CMV组比较，HFOV组可以降低患者病死率[OR：0．56，95％CI（0．38，0．81），P=0．002]，不增加并发症发生率[OR=0．00，95％CI（-0．12，0．12），P=0．96）]。对治疗后24、48、72h吸入氧浓度无明显影响（P〉0．05）。结论与CMV比较，HFOV可以降低成人ARDS患者病死率，不增加并发症发生率，对ARDS患者是安全可靠的。
Objective To determine clinical and physiological effects of high frequency oscillation ventilation （HFOV） compared with conventional mechanical ventilation （CMV） in adult patients with acute respiratory distress syndrome （ARDS）. Methods Pubmed database, the Cochrane Library, EMBASE, CBM, CNKI and other sources were used for retrieving the pertinent literature. All randomized controlled trials （RCTs） on HFOV treating ARDS patients were enrolled. The Cochrance Collaborationg software RevMan 5.2 was used for data analysis. Results Seven randomized controlled trials （n = 478 patients） were included （HFOV： 246 patients; CMV： 232 patients）. The mortality and the incidence of complications by I-IFOV treatment and C MV treatment were 31.3% （77/246） vs. 44.8% （104/232） and 25.9% （29/112） vs. 25.8% （25/97）, respectively. Meta - analysis of the 7 RCTs revealed HFOV did decrease the 30 days mortality of adult ARDS patients [ OR = 0.56, 95% CI （0.38, 0.81 ）, P = 0. 0021, and treatment failure were similar [ OR = 0.00, 95% CI（ - 0. 12, 0. 12）, P = 0. 96 ]. There were no significant differences in inspired fraction of oxygen at 24, 48, and 72 hours of treatment （ P 〉 0.05 ）. Conclusion Compared with CMV, HFOV for aduh ARDS patients might improve their survival rate and is relative safe without increasing the incidence of complications.
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第12期1088-1094,共7页
Chinese Journal of Critical Care Medicine
关键词
急性呼吸窘迫综合征
随机对照试验
高频振荡通气
系统评价
Acute respiratory distress syndrome
Randomized controlled trials
High frequency oscillation
Systematic review
