经鼻导管高流量吸氧在危重患者气管插管拔除后应用效果的Meta分析

目的探讨经鼻导管高流量吸氧在危重患者气管插管拔除后的应用效果。方法通过系统检索PUBMED,EMBASE,Cochrane Library、中国知网(CNKI)以及万方数据库,检索时间从建库到2016年5月31日。两名评价者独立地评价符合标准的随机对照临床研究并提取所需数据。使用Review Manager 5.3对提取到的数据进行分析。结果共计5篇文献纳入本研究,涉及1 957例患者。研究结果表明,经鼻导管高流量吸氧组与传统吸氧组患者拔管后的再插管率(OR=0.52,95%CI=0.21~1.29,P=0.16)及死亡率(OR=1.07,95%CI=0.70~1.63,P=0.75)差异无统计学意义,但经鼻导管高流量吸氧组患者的呼吸衰竭发生风险明显低于传统吸氧组患者(OR=0.48,95%CI=0.24~0.95,P=0.03);并且经鼻导管高流量吸氧组患者具有更好的舒适性。结论研究结果支持在气管插管拔除后的重症患者中使用经鼻导管高流量吸氧策略,但需更多高质量研究验证这一结果。

The effects of high-flow nasal cannula oxygen on critically ill patients after endotracheal extubation: A Meta-analysis

Objective To assess the effects of high-flow nasal oxygen on critically ill patients after endotracheal extubation.Methods PUBMED,EM-BASE,the Cochrane Library,China National Knowledge Infrastructure (CNKI) and Wanfang Data were systematically searched from their inception to May 31st,2016.Two authors independently reviewed and extracted from included randomized controlled clinical trials data.All data was analyzed by Review Manager Version 5.3.Results Five studies involving 1 957 patients were available in this study.Pooled results revealed that there were no significant difference between patients in high-flow nasal oxygen group (HFNC) and conventional oxygen group on re-intubation rate (OR =0.52,95％ CI =0.21 ～1.29,P =0.16) and mortality rate (OR =1.07,95％ CI =0.70 ～ 1.63,P =0.75).However,patients in HFNC group had a lower respiratory failure risk (OR =0.48,95 ％ CI =0.24 ～ 0.95,P =0.03) and had higher comfort scores than those in conventional oxygen group.Conclusion The findings of this study support the use of high-flow nasal oxygen therapy in critically ill patients after endotracheal extubation.However,more studies with high-quality are needed to confirm these outcomes.