无创高频振荡通气与经鼻间歇正压通气作为早产儿拔管后呼吸支持疗效比较的Meta分析

Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants:a Meta analysis

目的 系统评估无创高频振荡通气(non-invasive high-frequency oscillatory ventilation,NHFOV)与经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)作为早产儿拔管后呼吸支持的有效性及安全性。方法 全面检索中国知网、万方数据库、中国期刊全文数据库、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library等数据库中关于NHFOV与NIPPV作为早产儿拔管后呼吸支持的文献,检索时间从建库至2022年8月31日。采用RevMan 5.4软件及Stata 17.0软件进行Meta分析,比较NHFOV组和NIPPV组拔管后72 h内再插管率、改无创辅助通气后6~24 h的二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))及支气管肺发育不良(bronchopulmonary dysplasia,BPD)、气漏、鼻损伤、脑室周围白质软化(periventricular leukomalacia, PVL)、脑室内出血(intravetricularhemorrhage, IVH)及早产儿视网膜病变(retinopathyof prematurity,ROP)等发生率的差异。结果 共纳入9篇随机对照试验。Meta分析结果显示:NHFOV组拔管后72 h内再插管率低于NIPPV组(RR=0.67,95%CI:0.52~0.88,P=0.003);改无创辅助通气后6~24 h NHFOV组的PCO_(2)低于NIPPV组(MD=-4.12,95%CI:-6.12~-2.13,P<0.001)。两组BPD、气漏、鼻损伤、PVL、IVH及ROP等并发症发生率的比较差异无统计学意义(P>0.05)。结论 与NIPPV相比,NHFOV可有效清除二氧化碳,减少再插管风险,且不增加BPD、气漏、鼻损伤、PVL及IVH等并发症的发生,可作为早产儿拔管后序贯式呼吸支持模式。

Objective To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation(NHFOV) versus nasal intermittent positive pressure ventilation(NIPPV) as post-extubation respiratory support in preterm infants.Methods China National Knowledge Infrastructure,Wanfang Data,Chinese Journal Fulltext Database,China Biology Medicine disc,PubMed,Web of Science,and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31,2022.RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups,including reintubation rate within 72 hours after extubation,partial pressure of carbon dioxide(PCO_(2)) at 6-24 hours after switch to noninvasive assisted ventilation,and the incidence rates of bronchopulmonary dysplasia(BPD),air leak,nasal damage,periventricular leukomalacia(PVL),intraventricular hemorrhage(IVH),and retinopathy of prematurity(ROP).Results A total of 9 randomized controlled trials were included.The Meta analysis showed that compared with the NIPPV group,the NHFOV group had significantly lower reintubation rate within 72 hours after extubation(RR=0.67,95%CI:0.52-0.88,P=0.003) and PCO_(2) at 6-24 hours after switch to noninvasive assisted ventilation(MD=-4.12,95%CI:-6.12 to-2.13,P<0.001).There was no significant difference between the two groups in the incidence rates of complications such as BPD,air leak,nasal damage,PVL,IVH,and ROP(P>0.05).Conclusions Compared with NIPPV,NHFOV can effectively remove CO_(2) and reduce the risk of reintubation,without increasing the incidence of complications such as BPD,air leak,nasal damage,PVL,and IVH,and therefore,it can be used as a sequential respiratory support mode for preterm infants after extubation.