经鼻高流量氧疗对比无创机械通气对有创机械通气序贯疗效的Meta分析

Meta-analysis of sequential efficacy of intranasal high-flow oxygen therapy versus noninvasive mechanical ventilation in invasive mechanical ventilation

目的 经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)对比无创机械通气(non-invasive mechanical ventilation,NIV)对有创机械通气序贯的疗效分析。方法 计算机检索中国期刊全文数据库、维普期刊数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library及Embase,纳入HFNC对比NIV序贯有创机械通气的疗效的随机对照实验,使用RevMan5.4软件进行meta分析。结果 最终纳入19项研究,共计2 404例。Meta分析结果显示:HFNC对比NIV在有创机械通气序贯中,在降低患者再插管率方面,HFNC较NIV差异有统计学意义[相对危险度(relative risk,RR)=0.65,95%置信区间(95%confidence interval,95%CI)0.50~0.86,Z=3.10,P=0.002]。在降低肺部感染率方面,HFNC较NIV差异有统计学意义(RR=0.40,95%CI 0.21~0.79,Z=2.67,P=0.008)。在减少重病加强治疗病房(intensive Care Unit,ICU)住院时间方面,HFNC较NIV差异有统计学意义[平均差(mean difference,MD)=–5.77,95%CI–7.64~–3.90,Z=6.05,P<0.000 01]。在改善24 h氧合指数方面,HFNC较NIV差异有统计学意义(MD=13.16,95%CI 8.77~17.55,Z=5.87,P<0.000 01)。在ICU住院死亡率方面,HFNC较NIV差异无统计学意义(RR=0.70,95%CI 0.45~1.08,Z=1.61,P=0.11)。结论 相较于NIV,HFNC在有创机械通气序贯应用中能在一定程度上改善再插管率、肺部感染率,还可减少ICU住院时间并改善24 h氧合指数,而在ICU住院死亡率方面则无差异,值得临床推广应用。

Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy(HFNC)with non-invasive mechanical ventilation(NIV).Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database,VIP Journal database,Wanfang Database,Chinese Biomedical Literature Database,PubMed,Cochrane Library and Embase.Meta-analysis was performed using RevMan5.4 software.Results A total of 2404 subjects were included in 19 studies.Meta-analysis results showed that compared with NIV,HFNC had a statistically significant difference in reducing patients're-intubation rate in invasive mechanical ventilation sequence[relative risk(RR)=0.65,95%confidence interval(CI)0.50-0.86,Z=3.10,P=0.002].HFNC showed statistically significant difference compared with NIV in reducing lung infection rate(RR=0.40,95%CI 0.21-0.79,Z=2.67,P=0.008).HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit(ICU)(MD=–5.77,95%CI–7.64-–3.90,Z=6.05,P<0.00001).HFNC was significantly different from NIV in improving 24 h oxygenation index(MD=13.16,95%CI 8.77-17.55,Z=5.87,P<0.00001).There was no significant difference in ICU mortality between HFNC and NIV(RR=0.70,95%CI 0.45-1.08,Z=1.61,P=0.11).Conclusion Compared with NIV,sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent,reduce the length of ICU stay and improve the 24 h oxygenation index,while there is no difference in ICU mortality,which is worthy of clinical application.