加温湿化高流量鼻导管通气预防呼吸窘迫征早产儿鼻损伤有效性的Meta分析

Meta-Analysis of Effectiveness of Heated Humidified High-flow Nasal Cannulae in Preventing Nasal Injury in Premature Infants with Respiratory Distress Syndrome

目的系统评价加温湿化高流量鼻导管通气(heated humidified high flow nasal cannulae,HHHFNC)预防呼吸窘迫综合征(respiratory distress syndrome,RDS)早产儿鼻损伤的有效性,为临床实践提供参考。方法检索PubMed、Embase、维普、知网等数据库有关HHHFNC预防RDS早产儿鼻损伤的随机对照研究,检索时限为建库至2024年3月。运用Stata 16.0和RevMan 5.3进行Meta分析,最后采用Grade系统进行证据质量评价。结果共纳入35篇随机对照试验,研究对象3502名。Meta分析结果显示,试验组(HHHFNC)在鼻损伤发生率[RR=0.28,95%CI(0.23,0.35),P<0.001]、气漏发生率[RR=0.30,95%CI(0.18,0.49),P<0.001]方面均低于对照组(其他无创通气模式)。Grade证据分级结果显示:鼻损伤发生率、气漏发生率2项结局指标均为中等质量证据。结论使用HHHFNC可降低RDS早产儿鼻损伤的发生。

Objective To systematically evaluate the effectiveness of heated humidified high-flow nasal cannulae(HHHFNC)in preventing nasal injuries in premature infants with respiratory distress syndrome(RDS).Methods Randomized controlled studies on HHHFNC prevention of nasal injuries in premature infants with RDS were searched in PubMed,Embase,VIP,CNKI and other databases.The retrieval timeframe was from the inception to March 2024.Stata16.0 and RevMan 5.3 were used for meta-analysis,and Grade system was used to evaluate the quality of evidence.Results A total of 35 RCTS were retrieved and 3502 subjects were studied.The results of Meta-analysis showed that the experimental group(HHHFNC)had significantly lower incidence of nasal injury[RR=0.28,95%CI(0.23,0.35),P<0.001]and air leakage[RR=0.30,95%CI(0.18,0.49),P<0.001]than the control group(other non-invasive ventilation modes).The results of the Grade evidence grading showed that the incidence of nasal injury and the incidence of air leakage were of medium quality.Conclusions The use of HHHFNC can reduce the incidence of nasal injuries in premature infants with RDS.