摘要
目的:系统评价高频振荡通气(HFOV)与常规机械通气(CMV)治疗急性呼吸窘迫综合征(ARDS)患者的安全性及有效性。方法:检索Pubmed、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库、维普数据库,查找所有比较HFOV与CMV治疗ARDS患者的临床研究,检索时间为建库至2024年7月31日。按照纳入及排除标准筛选文献并采用Revman 5.3软件进行Meta分析。结果:最终纳入23篇、共计3146例ARDS患者。安全性方面,HFOV组与CMV组治疗期间患者心率(P=0.300)、平均动脉压(P=0.170),中心静脉压(P=0.180)和死亡率(P=0.160)均无明显差异,但HFOV组并发症风险更低(OR=0.68,95%CI:0.56~0.83,P=0.002)。有效性方面,HFOV组与CMV治疗期间患者血气pH值(P=0.290)、平台压(P=0.230)、氧浓度(P=0.260)、总住院日(P=0.220)均无明显差异,但HFOV组患者机械通气时间更短(SMD=-0.85,95%CI:-1.26~-0.45,P<0.001);ICU住院日缩短(SMD=-1.05,95%CI:-1.27~-0.82,P<0.001);氧分压更高(SMD=0.63,95%CI:0.44~0.83,P<0.001);二氧化碳分压更低(SMD=-0.47,95%CI:-0.76~-0.19,P=0.001);氧合指数改善明显(SMD=0.82,95%CI:0.59~1.05,P<0.001)。结论:HFOV治疗ARDS的安全性及有效性较高,能够缩短ICU住院日,显著提升氧分压,降低二氧化碳分压并在改善氧合指数同时降低并发症风险。
Objective:To review systematically the safety and effectiveness of high-frequency oscillatory ventilation(HFOV)compared to conventional mechanical ventilation(CMV)in the treatment of acute respiratory distress syndrome(ARDS).Methods:All relevant randomised controlled trials comparing HFOV with CMV in ARDS patients were systematically searched in PubMed,Embase,The Cochrane Library,CNKI,CBM,WanFang,and VIP databases from inception to 31 July 2024.Studies were selected according to predefined inclusion and exclusion criteria,and meta~analysis was performed using RevMan 5.3.Results:Twenty-three studies containing as many as 3146 patients diagnosed with ARDS were included.In terms of safety,there was no significant difference in heart rate(P=0.300),mean arterial pressure(P=0.170),central venous pressure(P=0.180),or even mortality(P=0.160)between HFOV and CMV groups.The incidence of complications in the HFOV group was lower than in the CMV group(OR=0.68,95%CI:0.56~0.83,P=0.002).In terms of effectiveness,there were no significant differences in pH values(P=0.290),plateau pressure(P=0.230),oxygen concentration(P=0.260),and hospitalization days(P=0.220)between the two groups.In the HFOV group,the mechanical ventilation time(SMD=-0.85,95%CI:-1.26~-0.45,P<0.001)and the ICU length of stay(SMD=-1.05,95%CI:-1.27~-0.82,P<0.001)were shorter;oxygen partial pressure was much higher(SMD=0.63,95%CI:0.44~0.83,P<0.001);carbon dioxide pressure was lower(SMD=-0.47,95%CI:-0.76~-0.19,P=0.001)and oxygenation index improved significantly(SMD=0.82,95%CI:0.59~1.05,P<0.001)as compared with that respectively in the CMV group.Conclusion:HFOV is safe and effective in ARDS patients.It significantly shortens ICU length of stay,improves oxygenation index and PaO_(2),reduces PaCO_(2),and lowers the risk of complications.
作者
柳舟
张亮
李光
侯彦广
陈倩倩
彭卫
杨巧玉
詹丽英
LIU Zhou;ZHANG Liang;LI Guang;HOU Yanguang;CHEN Qianqian;PENG Wei;YANG Qiaoyu;ZHAN Liying(Department of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Department of Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Department of Respiratory and Critical Care Medicine,Yichang Central People's Hospital,Yichang 443003,Hubei,China)
出处
《武汉大学学报(医学版)》
2025年第11期1513-1522,共10页
Medical Journal of Wuhan University
基金
武汉市知识创新专项项目(编号:2023020201010165)
国家自然科学基金面上项目(编号:82272226)
武汉大学人民医院交叉创新人才项目(编号:JCRCZN-2022-017,JCRCZN-2022-005)。
关键词
高频振荡通气
常规机械通气
急性呼吸窘迫综合征
安全性
有效性
Meta分析
High Frequency Oscillatory Ventilation
Conventional Mechanical Ventilation
Acute Respiratory Distress Syndrome
Safety
Effectiveness
Meta-Analysis
