无创高频振荡通气治疗早产儿呼吸窘迫综合征疗效及安全性的Meta分析

Efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory distress syndrome in premature infants:a Meta-analysis

目的评价无创高频振荡通气(noninvasive high-frequency oscillatory ventilation,nHFOV)作为早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)初始呼吸支持模式的疗效及安全性。方法计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方数据库、维普及中国生物医学文献数据库,检索时间自建库至2022年3月1日,选择nHFOV与无创持续气道正压通气(noninvasive continuous positive airway pressure,NCPAP)应用于RDS早产儿初始治疗的随机对照试验(randomized controlled trials,RCT),采用Cochrane评价手册评价其质量,应用RevMan 5.4软件对纳入研究进行Meta分析。结果最终纳入7项RCT研究,共786例患儿,其中nHFOV组395例,NCPAP组391例。与NCPAP相比,使用nHFOV作为RDS早产儿的初始通气模式,可降低RDS患儿插管率(OR=0.34,95%CI 0.22~0.51,P<0.001)。两组病死率、并发症发生率比较差异均无统计学意义(P>0.05)。结论nHFOV应用于RDS早产儿的初始治疗,可降低早期治疗失败率,且不增加支气管肺发育不良等并发症发生率。

Objective To evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation(nHFOV)as the initial ventilation mode for respiratory distress syndrome(RDS)in premature infants.Methods From the establishment of the databases[(PubMed,Embase,Cochrane Library,CNKI,Wanfang database,CQVIP and CBM(SinoMed)]to March 1,2022,literature on randomized controlled trials(RCTs)using nHFOV and nasal continuous positive airway pressure(NCPAP)as the initial ventilation modes for RDS in premature infants were searched.The qualities of the included literature were evaluated according to Cochrane Evaluation Manual.RevMan 5.4 software was used for Meta-analysis.Results Seven RCTs involving 786 children were included for the final Meta-analysis,with 395 cases in the nHFOV group and 391 cases in the NCPAP group.The results showed that the nHFOV group had lower intubation rates than the NCPAP group(OR=0.34,95%CI 0.22~0.51,P<0.001).No significant differences existed in mortality rates and complication rates between the two groups(P>0.05).Conclusions nHFOV as the initial treatment for RDS in premature infants may reduce the incidence of early treatment failure without increasing complications.