摘要
目的系统评价高流量氧疗(HFNC)对免疫缺陷合并急性呼吸衰竭患者的应用效果。方法计算机检索PubMed、EMBASE、Cochrane Library以及中国知网、万方、维普数据库中有关HFNC对免疫缺陷合并急性呼吸衰竭患者疗效的随机对照试验(RCT)或队列研究,试验组采用HFNC,对照组采用面罩或鼻导管给氧方式的常规氧疗(COT)或无创正压通气(NIV)。2名研究者根据Cochrane协作网风险评估手册和纽卡斯尔–渥太华量表对纳入文献的研究方法进行质量评价和资料提取。采用RevMan 5.3软件进行Meta分析。主要结局指标:气管插管率、ICU病死率;次要结局指标:ICU住院时间。结果纳入13篇文献(RCT 4篇,队列研究9篇),共1133例研究对象,HFNC组583例、对照组550例(COT 280例、NIV 270例)。Meta分析结果显示,在降低免疫缺陷合并急性呼吸衰竭患者气管插管率方面,HFNC较COT差异有统计学意义(OR=0.49,95%CI 0.330.72,P=0.0003),而与NIV相比差异无统计学意义(OR=0.73,95%CI 0.521.02,P=0.07);两亚组合并分析显示,与COT/NIV相比,HFNC在降低气管插管率有明显优势(合并OR=0.61,95%CI 0.470.79,P=0.0002)。在ICU病死率方面,HFNC与COT(OR=0.59,95%CI 0.351.01,P=0.05)或NIV(OR=0.63,95%CI 0.440.91,P=0.01)差异均有统计学意义;两个亚组合并分析后结果仍未发生改变(合并OR=0.62,95%CI 0.460.83,P=0.002)。在ICU住院时间方面,HFNC较COT差异无统计学意义(MD=-4.52,95%CI-9.430.39,P=0.07),而与NIV相比差异有统计学意义(MD=-1.46,95%CI-2.41-0.51,P=0.003);两亚组合并分析结果显示差异有统计学意义(合并MD=-3.41,95%CI-6.16-0.66,P=0.01)。针对不同研究类型,再进行亚组分析后,分析结果与合并结果无差异。敏感性分析发现,与对照组氧疗相比,HFNC能显著缩短患者的ICU住院时间。漏斗图分析结果显示,纳入文献中有关气管插管率、ICU病死率的研究存在发表偏移;有关ICU住院时间的研究发表偏移较小。结论HFNC与COT相比可降低患者的气管插管率,但与NIV相比无明显差异;HFNC与COT/NIV相比可降低患者的ICU病死率;但由于研究间较高的异质性,HFNC是否能够减少ICU住院时间仍有待进一步探讨。
Objective To systematically evaluate the effect of high-flow nasal cannula in immunocompromised patients with acute respiratory failure.Methods Randomized controlled trials(RCT)or cohort studies on the efficacy of high-flow oxygen therapy in immunocompromised patients with acute respiratory failure were reviewed by computer in PubMed,EMBASE,Cochrane Library,and China Knowledge Network,Wanfang and VIP databases.The group used HFNC and the control group used a mask or a nasal catheter to give oxygen-based conventional oxygen therapy(COT)or noninvasive ventilation(NIV).Two investigators conducted quality assessments and data extractions based on the Cochrane Collaboration Risk Assessment Manual and the Newcastle-Ottawa Scale.Meta analysis was performed using RevMan 5.3 software.The main outcome measures included tracheal intubation rate,and intensive care unit(ICU)mortality.The secondary outcomes included ICU hospitalization time.Results The study included 13 articles(4 RCTs,9 cohort studies),a total of 1133 subjects,with 583 in the HFNC group and 550 in the control group(280 in the COT and270 in the NIV).Meta-analysis showed that HFNC was significantly different from COT in reducing tracheal intubation rate in immunocompromised patients with respiratory failure(OR=0.49,95%CI 0.33-0.72,P=0.0003),but no statistical significance compared with NIV(OR=0.73,95%CI 0.52-1.02,P=0.07);two-combination analysis showed that HFNC had a significant advantage in reducing tracheal intubation rate compared with COT/NIV(combined OR=0.61,95%CI 0.47-0.79,P=0.0002).In terms of ICU mortality,there was a statistically significant difference between HFNC and COT(OR=0.59,95%CI 0.35-1.01,P=0.05)or NIV(OR=0.63,95%CI 0.44-0.91,P=0.01).The results of the two subcombinations and analysis did not change(combined OR=0.62,95%CI 0.46-0.83,P=0.002).In terms of ICU hospital stay,there was no statistically significant difference between HFNC and COT(MD=-4.52,95%CI-9.43-0.39,P=0.07),but the difference was statistically significant compared with NIV(MD=-1.46,95%CI-2.41--0.51,P=0.003);the two sub-combinations and analysis results showed significant difference(combined MD=-3.41,95%CI-6.16--0.66,P=0.01).According to different research types,after subgroup analysis,the analysis results were not different from the combined results.Sensitivity analysis revealed that HFNC could significantly reduce the patient’s ICU hospital stay compared with the control group oxygen therapy.The results of the funnel chart analysis show that there were publication offsets in the studies on tracheal intubation rate and ICU mortality included in the literature;studies on ICU hospital stays had a smaller publication offset.Conclusions Compared with COT,HFNC can reduce the tracheal intubation rate of patients,but there is no significant difference compared with NIV;HFNC can reduce the ICU mortality of patients compared with COT/NIV.However,due to the high heterogeneity between the studies,whether HFNC can reduce ICU hospital stay remains to be further explored.
作者
刘玲
范杰梅
张爱琴
LIU Ling;FAN Jiemei;ZHANG Aiqin(Bengbu Medical College,Bengbu,Anhui 233000,P.R.China;Institute of Neurosurgery,Eastern War Zone General Hospital,Nanjing,Jiangsu 210002,P.R.China;Key Clinical Nursing Specialist,Eastern War Zone General Hospital,Nanjing,Jiangsu 210002,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2021年第1期22-31,共10页
Chinese Journal of Respiratory and Critical Care Medicine
基金
国家临床护理重点专科专项课题(2017086)。
关键词
高流量氧疗
免疫缺陷
急性呼吸衰竭
META分析
High-flow nasal cannula
Immunocompromised
Acute respiratory failure
Meta-analysis
