成年人心脏外科术后患者拔管后序贯应用经鼻高流量氧疗的Meta分析

Meta-analysis of sequential application of HFNC oxygen therapy after extubation of adult patients undergoing cardiac surgery

目的:探讨成年人心脏外科术后患者拔管后序贯应用经鼻高流量氧疗(HPNC)的效果。方法:检索中国知网(CNKI中国生物医学文献服务系统(CBM)、万方医学数据库、维普数据库(VIP)、Pub Med、Embase、Web of Science、Cochrane library数据库中关于HPNC用于成年人心脏外科术后患者的随机对照试验,并对文献进行筛选、资料提取及质量评价后,应用Review Manager 5.2软件对符合标准的文献进行Meta分析。结果:纳入的8项随机对照试验共1 306例患者,其中观察组654例,对照组652例。观察组可显著降低成年人心脏外科术后患者呼吸支持升级率和总住院时间,与对照组比较差异有统计学意义(Z=3.69,Z=2.61;P<0.05),但对患者再插管率、病死率、入住重症监护病房时间、氧疗后X射线胸片肺不张评分、呼吸困难改善率以及舒适度评分的影响,观察组与对照组比较差异均无统计学意义(Z=1.51,Z=0.61,Z=0.81,Z=0.79,Z=1.22,Z=1.01;P>0.05)。结论:HPNC与传统氧疗相比,能够降低成年人心脏外科术后患者的呼吸支持升级率和总住院时间,但对再插管率、病死率、入住重症监护病房时间、氧疗后X射线胸片肺不张评分、舒适度评分及呼吸困难等均无显著影响。

Objective:To investigate the effect of sequential application of high-flow nasal cannula(HFNC)oxygen therapy immediately after extubation of adult patients undergoing cardiac surgery.Methods:We searched databases including CNKI,CBM,VIP,PubMed,Embase,Web of Science,Cochrane library for including all randomized controlled trials which used HFNC oxygen therapy in postoperative adult patients of cardiac surgery.The Review Manager 5.2 software was applied to implement Meta-analysis for literature that met the standard after these literatures were screened,and data were extracted and quality was evaluated.Results:A total of 1306 patients in the included 8 randomized controlled trials were analyzed.654 cases and 652 cases of 1306 patients were in observation group and control group,respectively.The method of observation group could significant reduced the upgrade rate of respiratory support of patients post cardiac surgery and the total length of stay,and the differences of them between two groups were significant(Z=3.69,Z=2.61,P<0.05).While the differences of the effects of this method on reintubation rate,mortality,the time of admitting to intensive care unit(ICU),pulmonary atelectasis score of X-ray film post oxygen therapy,the improved rate of expiratory dyspnea and the score of comfort level between observation group and control group were not significant(Z=1.51,Z=0.61,Z=0.81,Z=0.79,Z=1.22,Z=1.01,P>0.05).Conclusion:Compared with conventional oxygen therapy,HFNC oxygen therapy can reduce the upgrade rate of respiratory support of patients post cardiac surgery and the total length of stay.While it doesn’t significant effects on reintubation rate,mortality,the time of admitting to intensive care unit(ICU),pulmonary atelectasis score of X-ray film post oxygen therapy,the score of comfort level and expiratory dyspnea.