头罩和面罩无创通气对急性呼吸衰竭患者疗效的荟萃分析

Efficacy of ventilation with a helmet versus face mask in patients with acute respiratory failure: a meta-analysis

目的采用荟萃分析方法研究在急性呼吸衰竭(ARF)患者中使用头罩和面罩无创通气的疗效。方法以"helmet,face mask,facial mask"和"mechanical ventilation或noninvasive ventilation"为英文检索词,检索Pub Med、OVID、Embase、Scopus和Cochrane等数据库,并搜索相关网页及参考文献。以"头罩、面罩、机械通气、无创通气"为中文检索词,检索中国知网和万方数据库。检索时间为建库至2016年12月。2名研究人员分别独立评估试验质量和提取信息。采用Revman 5.3对数据进行合并统计分析。结果最终纳入10项随机对照试验(RCTs)和6项病例对照试验。荟萃分析结果显示,与面罩相比,头罩无创通气降低气管插管率(OR=0.35,95%CI为0.24~0.51,P<0.000 01)、住院死亡率(OR=0.51,95%CI为0.34~0.76,P=0.001)、无创通气相关并发症(OR=0.10,95%CI为0.06~0.15,P<0.000 01)。在改善气体交换方面两组间没有显著差异。在亚组分析中,ARF的类型和通气模式不影响插管率和无创通气相关并发症,头罩无创通气主要降低低氧血症性ARF或压力支持通气患者的住院死亡率。结论头罩无创通气可以降低ARF患者的插管率、住院死亡率和无创通气相关并发症。头罩在改善患者气体交换方面与面罩同样有效。然而,未来仍需要更多的随机对照试验来进一步确定头罩无创通气的作用。

Objective This is a meta-analysis of the efficacy ofnoninvasive ventilation （NIV） with helmet compared to NIV with face mask in patients with acute respiratory failure （ARF）. Methods ＂Helmet, face mask or facial mask＂ and ＂mechanical ventilation or noninvasive ventilation＂ were used as key words both in Chinese and English to search all the trials in PubMed, OVID, Embase, Scopus and Cochrane Library, websites, reference lists of articles, CNKI and Wanfang Database from inception to December 2016. Two reviewers independently assessed the methodological quality of the trials and extracted information. Revman 5.3 was used for data analysis. Results Ten randomized controlled trials （RCTs） and six case-control trials were included. NIV with a helmet reduced the intubation rate （OR=0.35, 95%CI 0.24 to 0.51, P〈0.000 01）, in-hospital mortality rate （OR=0.51, 95%CI 0.34 to 0.76, P=0.001）, and NIV- related complications （0R=0.1095%C! 0.06 to 0.15, P〈0.000 01） compared to NIV with face mask. There was no significant difference in gas exchange between two groups. In the subgroup analysis, types of ARF and ventilation mode did not affect the intubation rate and the complications relevant to NIV, but NIV with helmet mainly decreased the in- hospital mortality of the patients with hypoxemic ARF or pressure support ventilation. Conclusions NIV with a helmet can decrease the endotracheal intubation rate, in-hospital mortality, and NIV-related complications of the patients with ARF. And helmet is as effective as face mask in improving the gas exchange. However, larger or multicenter RCTs are needed to analyze the role of NIV with a helmet in this condition.