无创高频振荡通气对比经鼻持续气道正压通气在新生儿呼吸窘迫综合征撤离有创呼吸机后疗效及安全性的meta分析

A meta-analysis of the efficacy and safety of non-invasive high-frequency oscillatory ventilation compared to nasal continuous positive airway pressure ventilation in neonates with respiratory distress syndrome after evacuating invasive ventilators

目的对无创高频振荡通气(nHFOV)与经鼻持续气道正压通气(nCPAP)作为新生儿呼吸窘迫综合征(NRDS)撤离有创呼吸机后过渡呼吸模式的临床效果进行可靠性评价。方法通过PubMed、Cochrane图书馆、Embase、中国知网、万方、维普数据库检索在2022年7月之前公开发表的文献,查找所有nHFOV和(或)nCPAP治疗NRDS有创通气撤机后的随机对照试验。比较NRDS撤离有创呼吸机后的新生儿中,nHFOV组和nCPAP组撤机成功率,气胸、支气管肺发育不良、脑室内出血等发生率的差异。结果共纳入7篇随机对照研究,包括598例诊断为NRDS并进行气管插管机械通气的新生儿。对所纳入文章中nHFOV组和nCPAP组患儿撤离有创呼吸机成功率进行计算,两组患儿撤离有创呼吸机成功率分别为88.5%(231/261)和66.5%(171/257),与nCPAP组相比,nHFOV组NRDS患儿撤离有创呼吸机的成功率更高(OR=3.93,95%CI:2.47~6.23,P<0.001),但NRDS患儿撤机后,两组支气管肺发育不良、脑室内出血及气胸发生率比较差异均无统计学意义(均P>0.05)。结论NRDS患儿撤离有创呼吸机后,nHFOV与nCPAP相比撤机成功率更高,值得临床应用。

Objective To evaluate the clinical efficacy of non-invasive high-frequency oscillatory ventilation(nHFOV)and nasal continuous positive airway pressure ventilation(nCPAP)as transitional breathing modes after evacuation from invasive ventilation in neonatal respiratory distress syndrome(NRDS).Methods A randomized controlled trial was conducted using PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases to search for all published literature before July 2022 on the treatment of NRDS with nHFOV and/or nCPAP after invasive ventilation and weaning.We compared the success rates of the evacuation,as well as the incidence of pneumothorax,bronchopulmonary dysplasia,and intraventricular hemorrhage between the nHFOV group and the nCPAP group in newborns who underwent invasive ventilation with NRDS.Results A total of 7 randomized controlled studies were included,including 598 newborns diagnosed with NRDS who underwent tracheal intubation mechanical ventilation.The success rates of evacuating invasive ventilators for children in the nHFOV and nCPAP groups included in the article were calculated.The success rates of evacuating invasive ventilators for children in the two groups were 88.5%(231/261)and 66.5%(171/257),respectively.Compared with the nCPAP group,the success rate of evacuating invasive ventilators for children with NRDS in the nHFOV group was higher(OR=3.93,95%CI:2.47-6.23,P<0.001).However,there was no statistically significant difference in the incidence of bronchopulmonary dysplasia,intraventricular hemorrhage,and pneumothorax between the two groups after weaning(all P>0.05).Conclusions After weaning NRDS patients with invasive ventilation,nHFOV has a higher success rate in weaning compared to nCPAP,which is worthy of clinical application.