高流量鼻导管吸氧对比经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征疗效的Meta分析

目的 系统评价高流量鼻导管吸氧（HFNC）对比经鼻持续气道正压通气（nCPAP）治疗新生儿呼吸窘迫综合征（RDS）的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库、中国知网和维普数据库建库至2020年4月1日的文献，收集HFNC对比nCPAP运用于新生儿RDS的随机对照试验（RCT）。采用RevMan5.3软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入12篇RCT文献，包括2 861例新生儿，其中胎龄≥28周2 698例（94.30%）， < 28周163例（5.70%）。在初始呼吸支持中，HFNC组治疗失败率高于nCPAP组（RR=1.86，95% CI：1.53~2.25，P < 0.001）；两组有创机械通气率（P=0.40）、肺表面活性物质使用率（P=0.77）的比较差异无统计学意义。在拔管后呼吸支持中，两组治疗失败率、重新插管率、总用氧时间的比较差异均无统计学意义（P > 0.05）。在初始呼吸支持和拔管后呼吸支持中，HFNC组的鼻损伤发生率均明显低于nCPAP组（P < 0.001）；HFNC组和nCPAP组病死率及气漏综合征、支气管肺发育不良、坏死性小肠结肠炎等并发症的发生率的比较差异均无统计学意义（P > 0.05）。结论 基于现有临床证据，HFNC作为新生儿RDS初始治疗时失败率高于nCPAP，不建议在新生儿RDS初始治疗时使用；在胎龄≥28周RDS新生儿撤机阶段可以考虑使用HFNC作为拔管后辅助呼吸支持。

Efficacy of high-flow nasal cannula versus nasal continuous positive airway pressure in the treatment of respiratory distress syndrome in neonates: a Meta analysis

Objective To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates. Methods PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs. Results A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥ 28 weeks and 163 (5.70%) had a gestational age of < 28 weeks. For primary respiratory support, the HFNC group had a significantly higher rate of treatment failure than the nCPAP group (RR=1.86, 95% CI:1.53-2.25, P < 0.001), but there were no significant differences between the two groups in the rate of invasive mechanical ventilation (P=0.40) and the rate of use of pulmonary surfactant (P=0.77). For post-extubation respiratory support, there were no significant differences between the two groups in the treatment failure rate, reintubation rate, and total oxygen supply time (P > 0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P < 0.001), and there were no significant differences between the two groups in the mortality rate and incidence rates of the complications such as air leak syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis (P > 0.05). Conclusions Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥ 28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.