头罩与面罩无创通气对呼吸衰竭患者临床疗效的Meta分析

Clinical efficacy of helmet and face mask noninvasive ventilation on patients with respiratory failure: a Meta-analysis

目的评价头罩与面罩无创通气方式对呼吸衰竭患者临床疗效的影响。方法通过检索文献数据库包括Medline(Pubmed)、Cochrane Library、Web of Science和万方数据、中国知网、中国生物医学文献数据库,根据纳入标准及剔除标准,筛选出比较头罩与面罩无创通气治疗呼吸衰竭的随机对照试验。提取数据,采用Cochrane协作网提供的“risk of bias”标准和Jadad评分体系进行文献质量评价。采用Review manager 5.1.0统计软件进行Meta分析。结果共纳入10篇随机对照试验,包括头罩组228例,面罩组223例。Meta分析显示,相比面罩,头罩可降低呼吸衰竭患者不耐受率(RR=0.18,95%CI:0.08~0.41,P<0.001),减少面部皮肤溃疡发生率(RR=0.19,95%CI:0.08~0.48,P<0.001)和胃肠胀气发生率(RR=0.15,95%CI:0.05~0.42,P<0.001),降低呼吸频率(MD=-3.01,95%CI:-4.87^-1.16,P=0.001)、气管插管率(RR=0.39,95%CI:0.26~0.59,P<0.001)和住院病死率(RR=0.59,95%CI:0.36~0.96,P=0.030),提高Ⅰ型呼吸衰竭患者氧合指数(MD=60.45,95%CI:20.44~100.46,P=0.003)。然而,在相同压力支持下,头罩降低Ⅱ型呼吸衰竭患者二氧化碳分压的能力低于面罩(MD=5.86,95%CI:3.64~8.08,P<0.001)。结论相比面罩,头罩可提高患者耐受性,减少不良反应,增加氧合作用,降低气管插管的风险,但在清除二氧化碳潴留方面无优势。

Objective To evaluate the clinical efficacy of helmet and face mask noninvasive ventilation on patients with respiratory failure. Methods By searching literature database including Medline(Pubmed), Cochrane Library, Web of Science, Wanfang, CNKI and Chinese Biological Medicine Database, randomized controlled trials comparing helmet and face mask noninvasive ventilation, which were defined as helmet group and face mask group, for patients with respiratory failure were selected according to inclusion and exclusion criteria. Data were extracted and quality assessment was conducted by using "risk of bias" criteria specified by the Cochrane Collaboration and Jadad scoring system. Meta-analysis was performed by using statistical software of Review manager 5.1.0. Results Overall, ten randomized controlled trials were included, with 228 cases in helmet group and 223 cases in face mask group. The Meta-analysis showed that, compared with face mask, helmet could significantly decrease the incidences of intolerance(RR=0.18,95%CI: 0.08-0.41,P<0.001), skin ulcer(RR=0.19,95%CI: 0.08-0.48,P<0.001) and gastric distension(RR=0.15,95%CI: 0.05-0.42,P<0.001), reduce the respiratory rate(MD=-3.01,95%CI:-4.87--1.16,P=0.001), endotracheal intubation rate(RR=0.39,95%CI: 0.26-0.59,P<0.001) and mortality(RR=0.59,95%CI: 0.36-0.96,P=0.030), and increase the oxygenation index of type-I respiratory failure(MD=60.45,95%CI: 20.44-100.46, P=0.003). How-ever, the ability of reducing PaCO2 of type-II respiratory failure of helmet was less than that of face mask(MD=5.86,95%CI: 3.64-8.08,P<0.001). Conclusion Compared with face mask, helmet can improve the patients’ tolerance, reduce the adverse events, increase the oxygenation effect, and decrease the risk of endotracheal intubation. Helmet has no advantage over face mask in eliminating the retention of CO2.