摘要
目的系统评价头罩式无创正压通气对成人急性呼吸衰竭患者疗效的影响。方法计算机检索Pub Med、The Cochrane Library(2016年11期)、Web of Science、EMbase、CBM、CNKI、Wan Fang Data,搜集关于头罩式无创正压通气(NPPV)治疗急性呼吸衰竭的随机对照试验(RCT)或队列研究,检索时限均为建库至2016年11月。由两名研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果最终纳入8个研究。Meta分析结果显示,头罩式NPPV能够显著降低ARF患者的Pa CO_2[队列研究:SMD=–0.46,95%CI(–0.75,–0.18),P=0.001]、气管插管率[RCT:OR=0.36,95%CI(0.17,0.77),P=0.008]和住院期间死亡率[RCT:OR=0.48,95%CI(0.24,0.98),P=0.044],提高呼吸末正压[RCT:SMD=1.27,95%CI(0.87,1.67),P<0.05]和改善呼吸频率[RCT:SMD=–0.45,95%CI(–0.81,–0.08),P=0.017];两组在NPPV治疗时间方面无明显差异[队列研究:OR=–0.20,95%CI(–0.50,0.09),P=0.177;RCT:OR=–0.24,95%CI(–0.86,0.38),P=0.445]。结论头罩式NPPV治疗AFR可降低患者Pa CO2、气管插管率、住院期间死亡率,提高呼吸末正压及改善呼吸状况方面具有优势,但在提高PaO_2/FiO_2、缩短NPPV治疗时间方面的效果尚不能确定。受纳入研究的数量和质量限制,上述结论尚待更多高质量研究予以验证。
Objective To systematically review the by helmet in adults with acute respiratory failure. Methods efficacy of noninvasive positive pressure ventilation （NPPV） Randomized controlled trials （RCTs） or cohort studies about noninvasive positive pressure ventilation （NPPV） by helmet in adults with acute respiratory failure were retrieved in PubMed, The Cochrane Library （Issue 11, 2016）, Web of Science, EMbase, CBM, CNKI and WanFang Data databases from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Stata 12.0 software was then used to perform meta-analysis. Results A total of eight studies were included. The results of meta-analysis showed that, NPPV by helmet could significantly reduce the carbon dioxide partial pressure （cohort study： SMD=-0.46, 95%CI -0.75 to -0.18, P=0.001）, tracheal intubation rate （RCT： OR=0.36, 95%CI 0.17 to 0.77, P=0.008） and hospital mortality （RCT： OR=0.48, 95%CI 0.24 to 0.98, P=0.044）, improve the positive end expiratory pressure （RCT： SMD= 1.27, 95%CI 0.87 to 1.67, P〈0.05） and respiratory status （RCT： SMD=-0.45, 95%CI -0.81 to -0.08, P=0.017）. There was no significant difference in the duration of NPPV（cohort study： OR=-0.20, 95%CI -0.50 to 0.09, P=0.177; RCT： OR=-0.24, 95%CI -0.86 to 0.38, P=0.445）. Conclusion NPPV by helmet can reduce the carbon dioxide partial pressure, tracheal intubation rate, hospital mortality and improve the positive end expiratory pressure, respiratory status. But the effects in the duration of NPPV and oxygenation index are uncertain. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
出处
《中国循证医学杂志》
CSCD
2017年第11期1283-1290,共8页
Chinese Journal of Evidence-based Medicine
基金
甘肃省卫生行业科研计划项目(编号:GSWSKY-2015-86)
关键词
头罩
无创正压通气
急性呼吸衰竭
队列研究
随机对照试验
META分析
Helmet
Noninvasive positive pressure ventilation
Acute respiratory failure
Cohort study
Randomized controlled trial
Meta-analysis
