高流量鼻腔疗法与非侵入性通风治疗AECOPD急性超性呼吸衰竭:随机对照试验的元分析
Jinlv Qin1, Guizuo Wang2, Yixing Liao3
1Radioimmunoassay Center, Shaanxi Provincial People's Hospital, No. 256, West Youyi Road, Xi'an, 710068, Shaanxi, China.
高流量鼻腔管 (HFNC) 在COPD患者的死亡率和输内管方面与非侵入性通风 (NIV) 并不劣. 然而,HFNC导致更多的治疗失败,并切换到NIV.
科学领域:
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 指导方针建议非侵入性通风 (NIV) 和高流量鼻腔管 (HFNC) 用于COPD患者的急性呼吸衰竭 (ARF).
- 在AECOPD患者的输管率和死亡率方面,HFNC与NIV的比较疗效尚不清楚.
研究的目的:
- 为了比较HFNC和NIV在患有AECOPD和超性ARF的患者中的疗效.
- 评估死亡率,输管率,治疗失败和HFNC和NIV疗法之间的治疗转换之间的差异.
主要方法:
- 在主要数据库 (PubMed,Embase,Cochrane图书馆,clinicaltrials.gov) 进行了系统的文献搜索.
- 包括随机对照试验 (RCT),将HFNC与NIV进行比较,用于AECOPD.
- 数据使用风险比率 (RRs) 与95%的置信区间 (CI) 进行了聚合.
主要成果:
- 分析了4项涉及486名患者的RCT.
- 在HFNC和NIV之间没有发现任何原因死亡率 (RR 0.97;95% CI 0.56-1.68) 或输管率 (RR 1.67;95% CI 0.99-2.83) 的显著差异.
- 治疗失败率 (RR 1.64;95% CI 1.04-2.60) 和治疗转换率 (RR 2.60;95% CI 1.54-4.38) 在HFNC中显著更高.
结论:
- 与NIV相比,HFNC与AECOPD患有超性ARF的患者的死亡率或输管率的增加无关.
- 治疗失败的更高发生率和需要NIV切换表明HFNC的潜在劣势.
- 研究结果表明,虽然HFNC可能不会增加死亡率,但它可以掩盖这种患者群体的潜在治疗无效性.
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