摘要
目的系统评价无创正压通气在慢性阻塞性肺疾病(COPD)急性发作时应用的效果及其预后。方法电子检索PubMed、EMBASE、Springer、外文生物医学期刊全文数据库和CBMdisc、CNKI,检索时间均从建库至2008年3月,检索纳入文献的参考文献,纳入无创正压通气(NPPV)用于COPD急性发作的所有随机对照试验验(RCT),并逐个进行质量评价和资料提取,并对缺少重要数据的文献向作者索取相关参数。统计学分析采用RevMan4.2.10软件处理。结果共纳入19个RCT(1236例)。Meta分析结果显示:(1)无创通气vs常规治疗:①插管率和失败率:无创组均比常规组发生率低,分别为[RR=0.36,95%CI(0.27,0.49)]和[RR=0.62,95%CI(0.43,0.90)];②病死率:无创组总体病死率低于常规组[RR=0.49,95%CI(0.34,0.69)],③治疗时间:无创组住院时间短于常规组[WMD=–3.83,95%CI(–5.78,–1.89)],但两者ICU时间无差异;④短时间血气变化:无创组无论在PaO2、PaCO2、还是pH上,变化均比常规组明显;⑤呼吸频率的变化:无创组比常规组的变化更加明显[WMD=–3.75,95%CI(–5.48,–2.03)];⑥病人出院和随访时的状态:从FEV1,pH,PaCO2,PaO2,肺活量上比较,两者均无差异。(2)无创通气vs有创通气:①病死率:ICU和住院期间的病死率无差异;②并发症:无创组明显比有创组低[RR=0.38,95%CI(0.20,0.73)];③治疗时间:在ICU时间、机械通气时间及撤机时间上,无创组均比有创组短;④无创组无论在病人出院时的状态还是出院后随访时的状态,与有创组相比,差异均无统计学意义。结论现有资料证明:在改善插管率、病死率、短时间内的血气值以及呼吸频率方面,NPPV优于常规通气;在治疗时间和并发症发生率上,NPPV优于有创通气;在治疗效果方面,无创通气与其它两组相似。
Objective To determine the efficacy and prognosis of noninvasive positive pressure ventilation （NPPV） in exacerbations of chronic obstructive pulmonary disease （COPD）. Methods Trials were located through electronic searches of MEDLINE, EMBASE, Springer, and Foreign Journals Integration System （from the start date to March 2008）. We also checked the bibliographies of retrieved articles. Statistical analysis was performed with The Cochrane Collaboration＇s software RevMan 4.2.10. Results A total of 19 trials involving 1 236 patients were included. Results showed that： （1） NPPV vs. conventional therapy： NPPV was superior to conventional therapy in terms of intubation rate （RR 0.36, 95%CI 0.27 to 0.49）, failure rate （RR 0.62, 95%CI 0.43 to 0.90）, and mortaliW （RR 0.49, 95%CI 0.34 to 0.69）. The length of hospital stay was shorter in the NPPV group compared with the conventional group （WMD -3.83, 95%CI -5,78 to -1.89）, but the length of ICU stay was similar. The changes of PaO2, PaCO2, and pH were much more obvious in the NPPV group compared with the conventional group. The change of respiratory rate was more significant in the NPPV group compared with the conventional group （WMD -3.75, 95%CI -5.48 to -2.03）. At discharge and follow-up, there were no significant differences in FEV1, pH, PaCO2, PaO2, and vital capacity between the two groups. （2） NPPV vs. invasive ventilation： the mortality was similar between the two groups. The incidence of complications was lower in the NPPV group compared with the invasive group （RR 0.38, 95%CI 0.20 to 0.73）. The length of ICU stay, duration of mechanical ventilation, and weaning time were shorter in the NPPV group than those of the invasive group. At discharge and follow-up, clinical conditions were similar between the two groups. Conclusion The limited current evidence showed that NPPV was superior to conventional therapy in improving intubation rate, mortality, short term of blood-gas change, the change of respiratory rate; and superior to invasive ventilation in the length of hospital stay and the incidence of complication. There were no difference among them in discharge and follow-up.
出处
《中国循证医学杂志》
CSCD
2008年第12期1112-1121,共10页
Chinese Journal of Evidence-based Medicine
关键词
慢性阻塞性肺部疾病
无创正压通气
系统评价
Chronic obstructive pulmonary disease
Noninvasive positive pressure ventilation
Systematic review
作者简介
孙捷豪，男（1983年～），中国医科大学盛京医院麻醉科硕士。E-mail：sunjiehao@126．com
通讯作者，E-mail：wuxiuying0415@163．com
