经鼻高流量氧疗与无创正压通气治疗COPD伴Ⅱ型呼吸衰竭的Meta分析

Meta-analysis about High-Flow Nasal Cannula Oxygen Therapy and Noninvasive Ventilation in the Treatment of COPD with TypeⅡRespiratory Failure

目的:系统评价经鼻高流量氧疗(HFNT)与无创正压通气(NIV)治疗慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭的安全性及有效性。方法:用计算机检索PubMed、The Cochrane Library、EMBASE、CBM、CNKI、VIP和Wanfang Data等数据库,查找关于HFNT与NIV治疗COPD疗效的随机对照试验(RCT),检索时限均为从建库至2020年4月。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入11个RCT,906例患者。综合分析结果表明,HFNT组12 h-动脉血氧分压(PaO_(2))和48 h-PaO_(2)均高于NIV组(P<0.05)。HFNT组与NIV组相比,48 h-动脉血二氧化碳分压(PaCO_(2))水平更高(P<0.05)。两组治疗后12 h-PaCO_(2)、24 h-PaO_(2)、24 h-PaCO_(2)、24 h-氢离子浓度指数(pH)、48 h-pH、72 h-PaO_(2)、72 h-PaCO_(2)、72 h-pH相比较,差异无统计学意义(P>0.05)。结论:在COPD合并Ⅱ型呼吸衰竭患者的治疗中,与NIV相比,使用HFNT并没有导致治疗失败率的增加,且HFNT具有更好的舒适性和耐受性,是一种新型潜在的COPD伴Ⅱ型呼吸衰竭呼吸支持治疗方法。

Objectives:To systematically evaluate the safety and efficacy of high-flow nasal cannula oxygen therapy(HFNT)and noninvasive ventilation(NIV)in treating patients with chronic obstructive pulmonary diseases(COPD)with typeⅡrespiratory failure.Methods:PubMed,the Cochrane Library,EMBASE,CBM,CNKI,VIP and Wanfang Data were searched by computer to find the randomized controlled trials(RCTs)on the efficacy of HFNT and NIV in the treatment of COPD.The search time was from the establishment of the database to April 2020.Two researchers screened the literatures,extracted datas and evaluated the methodological quality of the included study according to the inclusion and exclusion criteria,and then performed meta-analysis with RevMan 5.3 software.Results:A total of 11 RCTs and 906 patients were included.The results of comprehensive analysis showed that the 12 h-arterial oxygen partial pressure(PaO_(2))and 48 h-PaO_(2) in HFNT group were higher than those in the NIV group(P<0.05).The level of 48 h-arterial partial pressure of carbon dioxide(PaCO_(2))in HFNT group was higher than that in the NIV group(P<0.05).There was no significant difference between the two groups in 12 h-PaCO_(2),24 h-PaO_(2),24 h-PaCO_(2),24 h-hydrogen ion concentration index(pH),48 h-pH,72 h-PaO_(2),72 h-PaCO_(2) and 72 h-pH after treatment(P>0.05).Conclusion:In the treatment of COPD patients with typeⅡrespiratory failure,compared with NIV,the use of HFNT does not lead to the increase of treatment failure rate,and HFNT has better comfort and tolerance.It is a new potential respiratory support treatment for COPD with typeⅡrespiratory failure.