湿化与非湿化中低流量鼻导管吸氧临床效果的系统评价

Clinical Effects of Non-humidified versus Humidified Low-to-moderate Flow Oxygen Inhalation Therapy via Nasal Cannula:A Systematic Review

目的系统评价湿化与非湿化中低流量鼻导管吸氧临床应用的效果。方法计算机检索The Cochrane Library(2016年3期)、JBI循证卫生保健数据库、EMbase、Pub Med、Web of Science、CBM、CNKI、VIP和Wan Fang Data中关于成年住院患者应用湿化与非湿化中低流量鼻导管吸氧的随机对照试验(RCT)、临床对照试验(CCT)和交叉试验,检索时限均为建库至2016年3月。由3名研究者独立筛选文献、资料提取和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入9个RCT及3个CCT,共3 756例患者。Meta分析结果显示,湿化组与非湿化组在改善患者的鼻咽部干燥感[RR=1.08,95%CI(0.91,1.29),P=0.37]、鼻黏膜出血症状[RR=1.17,95%CI(0.66,2.08),P=0.59]及吸氧不适感[RR=0.80,95%CI(0.56,1.14),P=0.22]方面,差异无统计学意义;但非湿化吸氧组可以减少吸氧装置细菌污染(P<0.05),与每日更换湿化水相比可减少护士操作时间(P<0.05)。结论中低流量非湿化鼻导管吸氧和湿化吸氧在缓解患者鼻部干燥感、鼻黏膜出血及不适感方面无差异,但非湿化吸氧能减少吸氧装置的细菌污染,简化护理操作流程,减少护士工作时间。

ObjectiveTo systematically review the clinical effects of non-humidified versus humidified low-to-moderate flow oxygen inhalation therapy via nasal cannula. MethodsRandomized controlled trials （RCTs）, clinical controlled trials （CCTs） and cross-over studies about the clinical effects of non-humidified versus humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in hospitalized adult patients were searched in The Cochrane Library （Issue 3, 2016）, The Joanna Briggs Institute Evidence Based Practice （EBP） Database, EMbase, PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data from inception to March 2016. Three reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of nine RCTs and three CCTs involving 3 756 patients were finally included. The results of meta-analysis indicated that： non-humidified was superior to humidified oxygen therapy in reducing bacterial contamination of oxygen apparatus （P 〈 0.05） and the time of daily replacement of sterile water oxygen humidifier bottles （P 〈 0.05）, while the two groups were alike in relieving nasal dryness （RR=1.08, 95%CI 0.91 to 1.29, P=0.37）, nasal bleeding （RR=1.17, 95%CI 0.66 to 2.08, P=0.59） and discomfort （RR=0.80, 95%CI 0.56 to 1.14, P=0.22）. ConclusionCurrent evidence indicates that there is no significant difference between non-humidified and humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in relieving patients＇ nasal dryness, nasal bleeding and discomfort. But non-humidified oxygen therapy can reduce bacterial contamination of oxygen apparatus, simplify the operation procedures and lessen nurses＇ operation time.