无创通气设备不同连接方式对NICU患儿鼻部压力性损伤的网状Meta分析

Nasal pressure injury in children in NICU by different non-invasive ventilation device connections:a network meta-analysis

目的 采用网状Meta分析评价无创通气设备不同连接方式对NICU患儿鼻部压力性损伤发生的影响。方法 全面检索中英文数据库中通过不同连接方式进行无创通气的随机对照试验,检索时间为建库至2023年3月。按照文献纳入、排除标准筛选文献,并进行质量评价和数据提取。采用StataSE14.0软件进行网状Meta分析。结果 共纳入24篇文献,涉及鼻塞、鼻面罩、鼻导管、交替使用鼻塞和鼻面罩、头盔、细长导管、带短鼻导管的面罩7种无创通气连接方式。网状Meta分析结果显示,鼻部压力性损伤发生概率从小到大依次为头盔、鼻导管、鼻面罩、交替使用鼻塞和鼻面罩、鼻塞;减少鼻部3期压力性损伤发生率排序第1名为交替使用鼻塞和鼻面罩。结论 头盔与其他连接方式比较的置信区间大,可信度不高。推荐鼻导管作为NICU患儿无创通气的最佳连接方式。交替使用鼻塞和鼻面罩可以减少鼻部3期压力性损伤的发生,可结合医院实际情况进行选择。

Objective To evaluate the influence of different interface of non-invasive ventilation equipment on nasal pressure injury in children in NICU by using network meta-analysis.Methods Chinese and English databases were searched comprehensively for non-invasive ventilation through different connection interfaces.The search period was from database construction to March 2023.Literature was screened according to inclusion and exclusion criteria,and quality evaluation and data extraction were carried out.StataSE14.0 software was used to conduct network meta-analysis.Results A total of 24 literatures were included,involving 7 non-invasive ventilation connections including nasal prongs,nasal mask,nasal cannula,rotation use of nasal prongs and nasal mask,helmet,long and narrow tubing,and short binasal prongs and mask.The results of network meta-analysis showed that the probability of nasal pressure injury from small to large was helmet,nasal cannula,nasal mask,rotation use of nasal prongs and nasal mask,and nasal prongs.Reducing the incidence of GradeⅢnasal stress injury ranked first as rotation nasal prongs and nasal mask.Conclusion The helmet has a larger confidence interval and is less reliable than other connection methods.Nasal cannula is recommended as the best interface for non-invasive ventilation in children in NICU.Rotation use of nasal prongs and nasal mask can reduce the occurrence of nasal stress injury of GradeⅢ,which can be selected according to the actual situation of the hospital.