无创正压通气治疗对急性呼吸衰竭患者 拔管后再插管和病死情况的影响

目的 明确无创正压通气（NPPV）治疗方式对急性呼吸衰竭（RF）患者拔管后再插管率和病死率 的影响。方法 联合检索美国国家生物技术信息中心（NCBI PubMed）、中国知网（CNKI）及万方数据库，查 询2000 年以来有关NPPV 对RF 患者拔管后进行呼吸支持和治疗的随机对照试验研究，采用Stata 12.0 统计软 件对数据进行分析，以合并Ol ^ R 值及95%CI 评价对拔管后NPPV 辅助治疗患者的再插管率和病死率。结果 依据纳入和排除标准，共9 篇临床随机对照研究，研究对象996 例。其中，NPPV 治疗组518 例，常规治疗 组478 例。NPPV 治疗组和常规治疗组再插管率为40/518（7.7%） vs 110/478（23.0%）（P <0.05）；病死率为 35/518（6.8%） vs 83/478（17.4%）（P <0.05）。与常规治疗组比较，拔管后NPPV 治疗可降低患者再插管和病 死的发生风险，相应Ol ^ R=0.260 和0.340，（95%CI ：0.180，0.390）和（95%CI ：0.220，0.510）]。结论 RF 患 者拔管后NPPV 治疗有助于降低患者再插管和病死的发生风险。

Systematic effect of noninvasive positive pressure ventilation on reintubation and mortality in patients with acute respiratory failure

Objective To evaluate the effect of noninvasive positive pressure ventilation (NPPV) treatment on the reintubation rate and mortality in patients with acute respiratory failure after extubation. Methods Randomized controlled trials of NPPV on respiratory support and therapy of patients with acute respiratory failure after extubation since 2000 were referred in NCBI PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang database. Stata 12.0 software was used for data analysis. The odds ratio (O^R) and corresponding 95% confidence interval (95% CI) were used to assess the reintubation rate and death rate of NPPV adjuvant treatment and conventional therapy. Results According to the inclusion and exclusion criteria, a total of 9 clinical randomized controlled trials were conducted with 996 patients, of whom 518 were in the NPPV treatment group and 478 were in the conventional treatment group. The reintubation rate of NPPV treatment group and conventional treatment group was respectively 7.7% (40/518) and 23.0% (110/478), the difference was statistically significant (P < 0.05); the mortality rate was respectively 6.8% (35/518) and 17.4 (83/478), the difference was statistically significant (P < 0.05). Compared with conventional treatment, NPPV treatment significantly reduced the risk of reintubation and mortality after extubation O^R = 0.260 and 0.340, (95% CI: 0.180, 0.390) and (95% CI: 0.220, 0.510)]. Conclusion NPPV treatment after extubation help to reduce the risk of reintubation and mortality in patients with acute respiratory failure.