纳洛酮联用无创正压通气治疗慢性阻塞性肺病合并呼吸衰竭的Meta-分析

Meta-analysis of naloxone combined with noninvasive positive pressure ventilation for treatment of acute exacerbation of chronic obstructive pulmonary with respiratory failure

目的系统评价纳洛酮联用无创正压通气(NIPPV)治疗慢性阻塞性肺病急性加重(AECOPD)合并呼吸衰竭的有效性和安全性,为临床提供循证医学证据。方法计算机检索PubMed、Medline、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)和万方等数据库,收集纳洛酮联用NIPPV对比单用NIPPV治疗AECOPD合并呼吸衰竭的随机对照研究(RCTs),检索时限均为2000年1月至2018年1月,提取有效数据后采用RevMan 5.2软件进行Meta-分析。结果纳入18篇RCTs,1 731例患者。Meta-分析结果显示,相对于单用NIPPV,纳洛酮联用NIPPV能显著提高临床有效率[RR=1.22, 95%CI (1.16～1.28), P<0.01]、降低住院死亡率[RR=0.37,95%CI(0.16～0.86),P=0.02]和再次插管率[RR=0.24,95%CI(0.12～0.48),P<0.01];显著增加氧分压[MD=9.75,95%CI(8.27～11.27,P<0.01)和血氧饱和度[MD=5.32,95%CI(3.14～7.50),P<0.01],显著降低二氧化碳分压[MD=-6.99,95%CI(-7.68～-6.29),P<0.01];降低住院时间[MD=-3.62,95%CI(-4.07～-3.06,P<0.01)]。两组均未发生不良反应。结论对于AECOPD合并呼吸衰竭患者,纳洛酮联用NIPPV能显著提高临床疗效,降低死亡率和再次插管率,改善血气分析指标,缩短住院时间。

Objective To systematically review the efficacy and safety of naloxone combined with noninvasive positive pressure ventilation(NIPPV)for treatment of acute exacerbation of chronic obstructive(AECOPD)with respiratory failure,and provide the evidence-based medical for clinical practice.Methods Databases including PubMed,Medline,CBM,CNKI,VIP and WanFang Data were searched to collect randomized controlled trials(RCTs)about naloxone combined with NIPPV vs alone NIPPV in the treatment of AECOPD with respiratory failure from January 2000 to January 2018.After extracting valid data,Meta-analysis was conducted by RevMan 5.2 software.Results A total of 18 RCTs(1731 patients)were included.Meta-analysis showed that,compared to the alone NIPPV,naloxone combined with NIPPV could improve the clinical effective rate[RR=1.22,95%CI(1.16-1.28,P<0.01)],reduce the in-hospital mortality[RR=0.37,95%CI(0.16-0.86),P=0.02],and the rate of re-intubation[RR=0.24,95%CI(0.12-0.48),P<0.01];significantly increased PaO2[MD=9.75,95%CI(8.27-11.27),P<0.01] and SaO2[MD=5.32,95%CI(3.14-7.50),P<0.01],significantly reduced the PaCO2[MD=-6.99,95%CI(-7.68-6.29),P<0.01];and reduce the time of hospitalization[MD=-3.62,95%CI(-4.07-3.06),P<0.01].There was no adverse reaction in two groups.Conclusion For patients with AECOPD combined with respiratory failure,naloxone combined with NIPPV can significantly improve the clinical efficacy,reduce mortality and re-intubation rate,improve blood gas analysis index,and shorten the time of hospitalization.