无创通气对急性心原性肺水肿患者院内病死率影响的荟萃分析

Efficacy of noninvasive ventilation on in-hospital mortality in patients with acute cardiogenic pulmonary edema： a meta-analysis

目的 探讨无创通气对急性心原性肺水肿（ACPE）患者院内病死率的影响.方法 检索PubMed、Embase、万方、中国期刊网数据库1980年1月至2012年12月无创通气治疗ACPE的英文和中文临床随机对照试验,按纳入与排除标准选择文献,提取资料.采用RevMan 5.1软件对数据进行荟萃分析.结果 共纳入35篇随机对照试验,3 204例患者.荟萃分析显示：与常规治疗比较,ACPE患者行持续正压通气（CPAP）可降低43％的院内病死率（RR =0.57,95％ CI 0.43 ～0.75,P＜0.01）,双水平正压通气（BiPAP）可降低31％的院内病死率（RR =0.69,95％ CI 0.51 ～0.94,P=0.02）.BiPAP在降低院内病死率方面与CPAP比较差异无统计学意义（RR=1.09,95％ CI 0.80 ～1.49,P=0.57）,且不增加心肌梗死事件（BiPAP与CPAP比较：RR =1.20,95％ CI 0.95 ～ 1.52,P=0.13；BiPAP与常规治疗比较：RR=1.10,95％ CI 0.88 ～ 1.38,P=0.40）.结论 无创通气可以降低ACPE患者的院内病死率,可以作为一线治疗措施.

Objective To evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema （ACPE） . Methods We searched PubMed, Embase,Wanfang, CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE,which were reported from January 1980 to December 2012. Meta-analysis was performed with software of RevMan 5.1. Results According to inclusive criteria and exclusion criteria, 35 randomized controlled trials with 3 204 patients were enrolled for analyses. Meta-analysis of the trials showed that continuous positive airway pressure （CPAP） reduced in-hospital mortality by 43% （ RR = 0. 57,95% CI 0. 43 - 0. 75, P 〈 0. 01 ） and bilevel positive pressure ventilation （BiPAP） reduced mortality by 31% （ RR = 0. 69,95 % CI 0. 51 - 0. 94, P = 0. 02） compared with standard therapy. There were no significant differences in in-hospital mortality between BiPAP and CPAP（ RR = 1.09,95% CI O. 80 - 1.49, P = 0. 57 ） and myocardial infarction rate（BiPAP vs. CPAP： RR - 1.20,95% CI 0. 95 - 1.52,P = 0. 12; BiPAP vs. standard therapy： RR = 1.10,95% CI 0. 88 - 1.38, P = 0.40 ）. Conclusion Noninvasive ventilation （ BiPAP and CPAP） could reduce in-hospital mortality of adult patients with ACPE, which could be used as first-line management strategies for these patients.