摘要
目的系统评价Helmet头罩无创通气与氧疗对低氧型呼吸衰竭(呼衰)患者的临床疗效。方法检索万方数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)以及美国国立医学图书馆PubMed、荷兰医学文摘(Embase)、Cochrane图书馆和科学网(Web of Science)发表的有关Helmet头罩无创通气与氧疗治疗低氧型呼衰的随机对照试验(RCT),检索时间从建库至2019年2月1日。研究结局指标包括氧合指数、动脉血二氧化碳分压(PaCO2)、气管插管率、住院病死率和不耐受率。由2名研究者独立进行文献检索及数据提取,采用Cochrane协作网提供的偏倚风险标准进行文献质量评价。采用RevMan 5.1.0软件进行Meta分析,并采用漏斗图及Egger回归法分析文献发表偏倚。结果共纳入6篇RCT,其中5篇英文文献,1篇中文文献;最终纳入547例患者,其中头罩无创通气组270例,氧疗组277例。文献质量评价提示总体偏倚风险低,文献质量相对较好,且漏斗图及Egger回归分析未发现有发表偏倚。Meta分析显示,头罩无创通气组氧合指数较氧疗组显著提高〔均数差(MD)=73.47,95%可信区间(95%CI)为52.01~94.92,P<0.00001〕,PaCO2(MD=-2.46,95%CI为-4.54^-0.39,P=0.02)、气管插管率〔相对危险度(RR)=0.38,95%CI为0.20~0.73,P=0.004〕和住院病死率(RR=0.35,95%CI为0.19~0.65,P=0.0008)均较氧疗组显著降低。两组患者不耐受率比较差异均无统计学意义(RR=2.38,95%CI为0.74~7.67,P=0.15)。结论与氧疗相比,Helmet头罩无创通气可有效改善低氧型呼衰患者的氧合指数,降低PaCO2,减少气管插管的发生,降低住院病死率,且具有良好的耐受性。
Objective To systematically evaluate the clinical efficacies of Helmet non-invasive ventilation and oxygen therapy on patients with hypoxemic respiratory failure.Methods The randomized controlled trials(RCTs)for comparison of efficacy between Helmet non-invasive ventilation and oxygen therapy for treatment of patients with hypoxemic respiratory failure published by Wanfang database,China National Knowledge Infrastructure(CNKI),China Biology Medicine(CBM),PubMed,Embase,Cochrane Library and Web of Science were retrieved.The retrieval time was from the establishment of database to February 1st,2019.The indexes of the study outcomes included oxygenation index,arterial partial pressure of carbon dioxide(PaCO2),endotracheal intubation rate,hospital mortality and intolerance rate.Literature search and data extraction was performed separately by two researchers.Quality assessment of literature was conducted according to the risk of bias criterion provided by Cochrane collaboration net.The extractive data were Meta-analyzed by RevMan 5.1.0.Funnel plot and Egger regression analysis was employed to detect publication bias.Results Six RCTs including 5 English studies and 1 Chinese study were selected.Finally,547 patients were enrolled,with 270 patients in Helmet non-invasive ventilation group and 277 in oxygen therapy group.The study quality assessment revealed that the overall risk of bias was low,and no publication bias was detected by the funnel plot and Egger regression analysis.Meta-analysis showed that the oxygenation index in Helmet non-invasive ventilation group was significantly higher than that in oxygen therapy group[mean difference(MD)=73.47,95%confidence interval(95%CI)was 52.01 to 94.92,P=0.00001],and PaCO2(MD=-2.46,95%CI was-4.54 to-0.39,P=0.02),endotracheal intubation rate[relative risk ratio(RR)=0.38,95%CI was 0.20 to 0.73,P=0.004]and hospital mortality(RR=0.35,95%CI was 0.19 to 0.65,P=0.0008)in Helmet non-invasive ventilation group were significantly lower than those in oxygen therapy group.There was no significant difference in patient's intolerance between the two groups(RR=2.38,95%CI was 0.74 to 7.67,P=0.15).Conclusion Compared with oxygen therapy,the Helmet non-invasive ventilation used for treatment of patients with hypoxemic respiratory failure can effectively improve the oxygenation index,decrease the PaCO2,reduce the endotracheal intubation rate and hospital mortality,and the patients are well tolerated to the Helmet method.
作者
洪树坤
田勇刚
李亚红
乔鲁军
Hong Shukun;Tian Yonggang;Li Yahong;Qiao Lujun(Department of Intensive Care Unit,Shengli Oilfield Central Hospital,Dongying 257034,Shandong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第9期1118-1122,共5页
Chinese Critical Care Medicine
基金
山东省医药卫生科技发展计划项目(2015WSA05010)。
关键词
头罩
无创通气
氧疗
氧合指数
META分析
Helmet
Non-invasive ventilation
Oxygen therapy
Oxygenation index
Meta-analysis
