中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

ICU 拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的 Meta 分析

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目的 系统评价重症加强治疗病房(ICU)患者拔除气管插管后使用经鼻高流量氧疗(HFNC)的临床有效性。 方法 检索 PubMed、Embase、Cochrane 图书馆、中国知网、万方、维普等数据库关于 HFNC 对拔除气管插管疗效的随机对照临床试验(RCT)或队列研究相关研究,试验组采用 HFNC,对照组采用面罩或鼻导管给氧方式的传统氧疗(COT)或无创正压通气(NIPPV)。由 2 名研究员按照纳入和排除标准筛选文献,评价纳入文献的质量并提取资料,使用 RevMan5.3 软件进行统计分析。主要结局观察指标:气管再插管率、ICU 留院天数;次要观察指标:ICU 死亡率、拔管后院内肺部感染率。 结果 纳入 20 篇文献(3 篇队列研究,17 篇 RCT 研究),共 3 583 例研究对象,HFNC 1 727 例,对照组 1 856 例(COT 841 例、NIPPV 1 015 例)。Meta 分析结果显示,在降低再插管率方面,HFNC 较 COT 有明显的优势(P<0.000 01),HFNC 与 NIPPV 比较差异无统计学意义(P=0.21);两亚组合并分析显示:与 COT/NIPPV 相比,HFNC 在减轻拔管后再插管率方面有明显优势(P<0.000 01);在 ICU 病死率方面,HFNC 与 COT(P=0.38)、与 NIPPV(P=0.36)比较差异均无统计学意义;在 ICU 住院天数方面,HFNC 与 COT(P=0.30)比较差异无统计学意义,与 NIPPV 比较差异有统计学意义(P<0.000 01),两个亚组合并分析后差异有统计学意义(P=0.04);拔管后院内肺部感染率方面,HFNC 与 COT(P=0.61)、与 NIPPV(P=0.23)比较差异均无统计学意义。针对不同研究类型,再进行亚组分析后,分析结果跟合并后无差异。 结论 对于拔管患者,HFNC 与 COT 相比,可降低气管再插管率,而 ICU 病死率、住院天数、院内肺部感染率差异无统计学意义;HFNC 与 NIPPV 相比,可降低住院天数,而气管再插管率、ICU 病死率、院内肺部感染率差异无统计学意义。

Objective To systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in post-extubation intensive care unit (ICU) patients. Methods The PubMed, Embase, Cochrane Library, CNKI, WanFang, VIP Databases were searched for all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy in post-extubation ICU patients. The control group was treated with conventional oxygen therapy (COT) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. Two reviewers separately searched the articles, evaluated the quality of the literatures, extracted data according to the inclusion and exclusion criteria. RevMan5.3 was used for meta-analysis. The main outcome measurements included reintubation rate and length of ICU stay. The secondary outcomes included ICU mortality and hospital acquired pneumonia (HAP) rate. Results A total of 20 articles were enrolled. There were 3 583 patients enrolled, with 1 727 patients in HFNC group, and 1 856 patients in control group (841 patients with COT, and 1 015 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over COT in reducing the reintubation rate of patients with postextubation (P<0.000 01), but there was no significant difference as compared with that of NIPPV (P=0.21). It was shown by pooled analysis of two subgroups that compared with COT/NIPPV, HFNC had a significant advantage in reducing reintubation rate in patients of postextubation (P<0.000 01). There was no significant difference in ICU mortality between HFNC and COT (P=0.38) or NIPPV (P=0.36). There was no significant difference in length of ICU stay between HFNC and COT (P=0.30), but there had a significant advantage in length of ICU stay between HFNC and NIPPV (P<0.000 01). It was shown by pooled analysis of two subgroups that compared with COT/NIPPV, HFNC had a significant advantage in length of ICU stay (P=0.04). There was no significant difference in HAP rate between HFNC and COT (P=0.61) or NIPPV (P=0.23). Conclusions There is a significant advantage to decrease reintubation rate between HFNC and COT, but there is no significant difference in ICU mortality, length of ICU stay or HAP rate. There is a significant advantage to decrease length of ICU stay between HFNC and NIPPV, but there is no significant difference in ICU mortality, reintubation rate or HAP rate.

关键词: 拔管后; 经鼻高流量湿化氧疗; 再插管率; ICU 住院天数; ICU 病死率; 院内肺部感染

Key words: Postextubation; High-flow nasal cannula oxygen therapy; Reintubation rate; Length of ICU stay; Intensive care unit mortality; Hospital acquired pneumonia

引用本文: 简佳庆, 段凤英, 肖远超, 张思颖, 高飞. ICU 拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的 Meta 分析. 中国呼吸与危重监护杂志, 2019, 18(1): 42-50. doi: 10.7507/1671-6205.201805050 复制

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