NIPPV治疗AECOPD伴Ⅱ型呼吸衰竭的Meta分析

Meta-analysis of Non-invasive Positive Pressure Ventilation Therapy in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Type Ⅱ Respiratory Failure

目的系统评价无创正压通气(non-invasive positive pressure ventilation,NIPPV)治疗慢性阻塞性肺疾病急性加重期(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)伴Ⅱ型呼吸衰竭的疗效。方法计算机检索Pub Med、EMbase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和万方数据库,并辅手工检索其他资料,纳入NIPPV治疗慢性阻塞性肺疾病急性加重期(AECOPD)伴Ⅱ型呼吸衰竭的随机对照试验(RCT),检索日期截至2014年6月。由两名研究者按照纳入与排除标准独立筛选文献、提取资料并对纳入研究进行质量评价。用Rev Man 5.0软件对数据进行Meta分析。结果共纳入9个RCT,共计593例患者。Meta分析结果显示:1早期联合应用NIPPV能改善患者动脉血气的Pa CO2值[MD=-10.22,95%CI(-13.41,-7.04),P<0.05]与Pa O2值[MD=13.09,95%CI(6.48,19.70),P<0.01],与对照组比较,差异有统计学意义;2NIPPV能有效降低患者的气管插管率[OR=0.42,95%CI(0.25,0.70),P<0.05],与对照组比较,差异有统计学意义;3NIPPV能有效改善患者的临床症状(心率与呼吸频率)[MD=-6.36,95%CI(-12.81,0.09),P=0.05;MD=-3.04,95%CI(-6.90,0.82),P=0.12],调节患者的酸碱平衡[MD=0.06,95%CI(0.03,0.09),P>0.05],但与对照组比较,差异无统计学意义。结论 NIPPV早期联合应用于AECOPD伴Ⅱ型呼吸衰竭患者并不能较常规治疗显著改善患者的临床症状,但能有效改善患者的动脉血气指标,降低气管插管的发生率。

Objective To estimate the effects of non-invasive positive pressure ventilation（ NIPPV） in patients with acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） and type Ⅱ respiratory failure. Methods The published literatures about randomized controlled trials（ RCT） of NIPPV in patients with AECOPD and type Ⅱ respiratory failure were selected from Pub Med,EMbase,Cochrane Library,CNKI,CBM and Wan Fang database,handsearches was used to collect other studies before the deadline of June 2014. According to the inclusive and exclusive criteria,the literatures and data were independently screened and confirmed by two researchers,meanwhile the quality of the included studies were assessed. Meta-analysis was conducted by Rev Man 5. 0 software. Result A total of nine RCT including 593 patients with AECOPD and type Ⅱ respiratory failure were enrolled. The meta-analysis demonstrated that： ① the early-term usage of NIPPV could improve Pa CO2[MD =-10. 22,95 % CI（- 13. 41,- 7. 04）,P〈0. 05]and Pa O2[MD = 13. 09,95% CI（ 6. 48,19. 70）,P〈0. 01]with significant differences compared with control group; ②the NIPPV could significantly reduce the rate of endotracheal intubation with significant differences compared with control group[OR = 0. 42,95 % CI（ 0. 25,0. 70）,P〈0. 05 ];③the NIPPV could improve clinical symptoms[MD =- 6. 36,95 % CI（- 12. 81,0. 09）,P = 0. 05; MD =- 3. 04,95 % CI（- 6. 90,0. 82）,P = 0. 12]and regulate acid-base balance[MD = 0. 06,95 % CI（ 0. 03,0. 09）,P〉0. 05]without significant differences compared with control group. Conclusion Compared with the conventional treatment,the NIPPV used in a early-term can not significantly improve clinical symptoms of patients with AECOPD and type Ⅱ respiratory failure,while it can effectively improve arterial blood gas（ ABG） index and reduce the rate of endotracheal intubation.