高流量呼吸湿化治疗仪对我国人工气道患者临床疗效的Meta分析

The Clinical Efficacy of High Flow Respiratory Humidification Therapeutic Apparatus on Patients with Artificial Airway in China:A Meta-Analysis

目的:评价高流量呼吸湿化治疗仪(AIRVO)对我国人工气道患者临床疗效的影响。方法:计算机检索PubMed、EMBASE、The Cochrane Library等电子数据库,查找自建库以来至2020年3月1日关于高流量呼吸湿化治疗仪和常规湿化法随机对照试验和准随机对照试验。由2位评价员独立筛选文献及提取资料,采用偏倚风险评估工具进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果:共纳入13个研究,包含1030例人工气道患者。Meta分析结果显示:⑴呼吸湿化治疗仪组痰液黏稠Ⅱ度的湿化效果明显优于常规湿化法[RR=1.50,95%CI(1.18,1.90),P=0.0008];⑵呼吸湿化治疗仪组的PaO_2[MD=14.82,95%CI(7.27,22.38),P=0.0001]和SpO_2[MD=3.48,95%CI(1.80,5.16),P<0.0001]均明显高于常规湿化法;⑶呼吸湿化治疗仪组的呼吸频率[MD=-3.98,95%CI(-7.25,-0.71),P=0.02]和心率[MD=-9.67,95%CI(-17.45,-1.88),P=0.01]明显低于常规湿化法;⑷呼吸湿化治疗仪组的痰痂形成率[RR=0.18,95%CI(0.10,0.34),P<0.00001]、呛咳发生率[RR=0.54,95%CI(0.37, 0.80),P=0.002]、肺部感染发生率[RR=0.32,95%CI(0.20,0.52),P<0.00001]明显低于常规湿化法。结论:当前证据显示,与常规湿化法相比,采用高流量呼吸湿化治疗仪可有效提高人工气道患者的湿化效果,提高患者的动脉血氧分压和血氧饱和度;同时,能有效降低人工气道患者的呼吸和心率,降低患者痰痂形成率、呛咳发生率和肺部感染发生率。鉴于受纳人研究文献文种和质量有限,上述结论尚需展开更多大样本、高质量的随机对照试验(RCT)予以验证。

Objective To systematically review the clinical efficacy of high flow respiratory humidification therapeutic apparatus(AIRVO) on artificial airway patients. Methods PubMed, EMBASE, the Cochrane Library and other electronic databases were searched to find the randomized controlled trials RCTs) and quasi randomized controlled trials(Q-RCTs) of high flow humidification therapeutic apparatus and conventional humidification method from the establishment of the database to March 1, 2020. Two reviewers independently screened the literature and extracted the data. The bias risk assessment tool was used for quality evaluation, and Revman 5.3 software was used for meta-analysis. Results A total of 13 RCTs involving 1030 artificial airway patients were included. The results of meta-analysis showed that: ⑴The humidification effects[Ⅱ degree sputum density(RR=1.50,95%CI 1.18 to 1.90,P=0.0008) ] in AIRVO was significantly superior to conventional humidifications;⑵PaO2(MD=14.82,95%CI 7.27 to 22.38,P=0.0001) and SpO2(MD=3.48,95%CI 1.80 to 5.16,P<0.0001) in AIRVO were significantly higher than conventional humidifications;⑶the respiratory rate(MD=-3.98,95%CI-7.25 to-0.71,P=0.02) and heart rate(MD=-9.67,95%CI-17.45 to-1.88,P=0.01) in AIRVO were significantly lower than those in conventional humidifications;⑷the rate of sputum scab formation(RR=0.18,95%CI 0.10 to 0.34,P<0.00001), the incidence of coughing(RR=0.54,95%CI 0.37 to 0.80, P=0.002), and the incidence of pulmonary infection(RR=0.32,95%CI 0.20 to 0.52,P<0.00001) in AIRVO were significantly lower than those in conventional humidifications. Conclusions Current evidence shows that, compared with conventional humidifications, the treatment of AIRVO could improve humidification effects, the arterial oxygen partial pressure and blood oxygen saturation of patients with artificial airway. Meanwhile, it could effectively decrease patients’ respiratory and heart rate, the incidence of sputum scab formation, cough and pulmonary infection. In view of the limited literature type and quality, more large sample and high-quality randomized controlled trials(RCTs) are needed to verify the above conclusions.