急性加重期COPD患者拔管后经鼻高流量氧疗效果的Meta分析

Effects of High Flow Nasal Cannula after extubation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease patients:a Meta analysis

目的:系统评价慢性阻塞性肺疾病急性加重期(AECOPD)患者拔除气管插管后使用经鼻高流量氧疗(HFNC)的临床有效性。方法:检索PubMed、Webofscience、CochraneLibrary、CNKI、万方、维普、中国生物医学网等数据库关于HFNC对AECOPD拔管后患者疗效的随机对照试验(RCT)或队列研究,试验组采用HFNC,对照组采用无创正压通气(NPPV)。结果:纳入10篇文献,其中6篇中文文献,4篇英文文献,共869位研究对象。Meta分析结果显示在降低ICU住院时间、呼吸频率以及并发症发生率的结局指标中,HFNC较NPPV有明显优势;但在患者的二氧化碳分压、氧合指数、血液酸碱度、死亡率以及再插管率结局指标中,两者差异无统计学意义。结论:当前证据表明HFNC在降低AECOPD拔管后患者的呼吸频率、ICU住院时间以及并发症的发生率中优于NPPV。未来仍需要更多高质量、多中心的RCT研究来进一步验证HFNC在AECOPD拔管后患者序贯应用的效果。

Objective:To systematically assess the clinical efficacy of High Flow Nasal Cannula(HFNC)after extubated in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD).Methods:The Pub Med,Web of science,Cochrane Library,CNKI,Wan Fang,VIP Databases and CBM were retrieved for all published Randomized Controlled Trials(RCT)or cohort studies about HFNC therapy in extubated AECOPD patients.The control group was treated with Noninvasive Positive Pressure Ventilation(NPPV).Results:Ten researches were included,of which six were Chinese and four were English.A total of 869 subjects were included.The results of Meta-analysis showed that HFNC had a significant advantage over NPPV in terms of reducing ICU hospital stay,respiratory rate,and complication rate.There were no significant statistical differences in PaCO2,oxygenation index,mortality and reintubation rate between NPPV and HFNC.Conclusion:Current evidence suggests that HFNC is superior to NPPV in reducing respiratory frequency,ICU hospital stay,and the incidence of complications in patients with AECOPD after extubation.In the future,more high-quality,multi-center RCT studies are needed to further evaluate the effect of HFNC on AECOPD patients after extubation.