经鼻高流量氧疗对急性低氧性呼吸衰竭患者预后影响的Meta分析

Meta-analysis of the effect of high-flow nasal cannula therapy on the prognosis of patients with acute hypoxic respiratory failure

目的评价经鼻高流量氧疗(HFNC)对急性低氧性呼吸衰竭(AHRF)患者预后的影响。方法检索Cochrane、Web of Scicence、Pumbed、ScienceDirect、OVID、Medline及谷歌学术(Google Scholar)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、维普数据库(VIP)和万方数据库(Wanfang Data),收集HFNC对AHRF患者预后影响的随机对照试验(RCTs)。检索时间均为建库起至2019年7月31日,以Revman5.3软件对数据进行统计分析处理。结果共纳入文献10篇,共1889名患者。Meta分析结果显示,HFNC与常规氧疗(COT)相比,可有效减缓患者的呼吸频率[MD=-2.39,95%CI(-3.36,-1.42),P<0.01],但不能提高患者的舒适度[MD=-0,17,95%CI(-0.64,0.31),P=0.49]和减少无创机械通气率[RR=0.79,95%CI(0.15,4.02),P=0.77]。同时在死亡率与插管率的结局比较上,经HFNC与COT相比,差异无统计学意义[RR=0.97,95%CI(0.82,1.14),P=0.69;RR=0.87,95%CI(0.75,1.01),P=0.06]。HFNC与无创机械通气(NIPPV)比较,可有效减慢患者的呼吸频率[MD=-2.00,95%CI(-3.77,-0.23),P=0.03],但对插管率无明显影响[RR=0.81,95%CI(0.61,1.06),P=0.12]。结论HFNC可以短期内改善AHRF患者的呼吸急促症状,但尚不能证明HFNC能够确切有效地减少AHRF患者的插管率及死亡率。

Objective To evaluate the effect of high-flow nasal cannula(HFNC)therapy on the prognosis of patients with acute hypoxic respiratory failure(AHRF),and provide evidence for clinical application.Methods Use of computer to search Cochrane,Web of scicence,Pumbed,ScienceDirect,OVID,Medine and Google Scholar,China Knowledge Network Full Text Database(CNKI),China Biomedical Literature Database(CBMdisc),VIP Database and Wanfang Database,to collect Randomized Controlled Trials(RCTs)about HFNC therapy for patients with AHRF.The data of included studies was statistically analyzed and processed by Revman 5.3 software.Results A total of 10 articles were included in the literature,with a total of 1889 patients.According to the meta-analysis,HFNC therapy can effectively reduce the respiratory rate of patients compared with conventional oxygen therapy(COT)(MD=-2.39,95%CI[-3.36,-1.42],P<0.01),but did not obviously improve patient’s comfort(MD=-0,17,95%CI[-0.64,0.31],P=0.49)and reduce non-invasive mechanical ventilation(RR=0.79,95%CI[0.15,4.02],P=0.77).In terms of mortality and intubation rate,there was no significant difference between HFNC and COT(RR=0.97,95%CI[0.82,1.14],P=0.69;RR=0.87,95%CI[0.75,1.01],P=0.06).Compared with non-invasive positive pressure ventilation(NIPPV),HFNC therapy could also effectively reduce the patient's respiratory rate(MD=-2.00,95%CI[-3.77,-0.23],P=0.03),but has no significant effect on intubation rate(RR=0.81,95%CI[0.61,1.06],P=0.12).Conclusion HFNC therapy can relieve the shortness of breath in patients with AHRF in a short period of time,but it has not been proven that nasal HFNC therapy could effectively reduce the intubation rate and mortality of patients with AHRF.