噻托溴铵联合无创呼吸机治疗慢阻肺急性加重合并Ⅱ型呼吸衰竭的Meta分析

Meta Analysis of Tiotropium and Noninvasive Ventilator in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Type Ⅱ Respiratory Failure

目的:系统评价噻托溴铵联合无创呼吸机治疗慢阻肺急性加重(AECOPD)合并Ⅱ型呼吸衰竭(RF)的应用。方法:全面检索数据库,检索有关噻托溴铵联合无创呼吸机治疗AECOPD合并Ⅱ型RF的相关随机对照研究,设定时间期限为2010年1月1日-2020年12月31日,剔除不符合纳入标准的文献,根据改良Jadad评分标准,评估文献质量。采用Review Manager 5.0软件录入文献内主要的结局指标数据,行Meta分析。结果:最终研究纳入文献10篇,研究对象共纳入943例;全部纳入的10篇文献中,报道第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)共7篇,报道FEV_(1)共5篇,报道FVC共6篇,报道动脉血氧分压(PaO_(2))共8篇,报道动脉血二氧化碳分压(PaCO_(2))共8篇,报道酸碱度(pH)共6篇,报道呼吸困难指数量表(MMRC)共6篇,均可提取有效数据;将全部主要结局指标数据录入后,经Meta分析结果显示,较单独行无创呼吸机治疗或行噻托溴铵而言,患者行噻托溴铵联合无创呼吸机治疗后,FEV_(1)/FVC、FEV_(1)、FVC、PaO_(2)、PaCO_(2)、pH、MMRC评分改善更明显(P<0.001)。结论:噻托溴铵联合无创呼吸机治疗AECOPD合并Ⅱ型RF有一定效果,可提高患者肺功能,改善血气指标,并减轻患者呼吸困难程度。

Objective:To systemically evaluate the application of Tiotropium Bromide combined with noninvasive ventilator in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with type Ⅱ respiratory failure(RF).Method:The database was searched comprehensively,and the randomized controlled study of Tiotropium and noninvasive ventilator in the treatment of AECOPD combined with type Ⅱ RF was searched,the time limit was from January 1,2010 to December 31,2020,the articles that did not meet the inclusion criteria were excluded,the quality of literature was evaluated according to the modified Jadad scoring system.The main outcome index data in the literature were entered by Review Manager 5.0 software and Meta analysis was performed.Result:The final study was included in 10 qualified literatures,and 943 subjects were included in the study;of the 10 documents that were included in the study,seven articles were reported in the first second forced expiratory volume as a percentage of forced vital capacity(FEV_(1)/FVC),5 were reported FEV_(1),6 were reported FVC,8 were reported partial pressure of blood oxygen(PaO_(2)),8 were reported partial pressure of blood carbon dioxide(PaCO_(2)),6 were reported potential of hydrogen(pH),6 were reported dyspnea index scale(MMRC),all of them could extract effective data;after all the main outcome indicators data were entered through Meta analysis,the results showed that compared with the single non-invasive ventilator or Tiotropium,the improvement of FEV_(1)/FVC,FEV_(1),FVC,PaO_(2),PaCO_(2),pH and MMRC scores of patients were more significant after the treatment with Tiotropium and noninvasive ventilator(P<0.001).Conclusion:Tiotropium combined with noninvasive ventilator has certain effect in the treatment of AECOPD combined with type Ⅱ RF,which can improve the lung function of patients,improve the blood gas index and reduce the degree of dyspnea of patients.