在急性心脏性肺水中进行非侵入性通风:系统性审查和元分析
Josep Masip1, Marta Roque, Bernat Sánchez
1ICU Department, Hospital Dos de Maig Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain. jmasip@ub.edu
JAMA
|December 29, 2005
概括
非侵入性通风显著降低了死亡率和急性心脏原发性肺患者的输内管的需要. 连续正气道压力 (CPAP) 和双层非侵入性压力支通风 (NIPSV) 是有效的,它们之间没有显著的结果差异.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 急性心脏性肺 (ACPE) 管理通常涉及非侵入性通风 (NIV) 以减少输管率.
- 然而,NIV对死亡率的影响和不同NIV技术的比较有效性仍然不清楚.
研究的目的:
- 系统地审查和定量综合NIV在ACPE患者的短期临床结果.
主要方法:
- 在MEDLINE,EMBASE和Cochrane数据库 (截至2005年10月) 的全面搜索中,确定了相关的随机对照试验和系统审查.
- 研究将NIV (CPAP或NIPSV) 与ACPE患者的常规氧气治疗进行了比较.
- 进行了元分析,以综合有关死亡率和输管率的数据.
主要成果:
- 分析了15项涉及NIV用于ACPE的试验.
- 与传统治疗相比,NIV显著降低了约45%的死亡率 (RR,0.55;95%CI,0.40-0.78).与传统治疗相比,NIV显著降低了约45%的死亡率 (RR,0.55;95%CI,0.40-0.78).
- 无论是CPAP还是NIPSV,都显著降低了输管的需要 (RR,0.43;95% CI,NIV组合的0.32-0.57).
结论:
- 在ACPE患者中,NIV有效降低死亡率和输管需求.
- 虽然CPAP的证据更强,但CPAP和NIPSV之间没有观察到临床结果的显著差异.
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