经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析

doi:10.3969/j.issn.1004-583X.2020.02.004

临床荟萃

经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析

1. 湖州师范学院，浙江湖州 313000；2.浙江省人民医院重症医学科，浙江杭州 310006

出版日期:2020-02-20 发布日期:2020-03-24
通讯作者: 徐菊玲，Email: xjl0125@zjhu.edu.cn

A metaanalysis: efficacy of highflow nasal cannula oxygen therapy in adult patients with severe immunosuppression

1.Huzhou University, Huzhou 313000, China; 2.Department of Critical Care Medicine,
Zhejiang Provincial People's Hospital, Hangzhou 310006, China

Online:2020-02-20 Published:2020-03-24
Contact: Corresponding author: Xu Juling, Email: xjl0125@zjhu.edu.cn

摘要/Abstract

摘要： 目的系统评价经鼻高流量湿化氧疗（HFNC）在成人重症免疫抑制患者的应用疗效。方法计算机检索PubMed、Embase、Cochrane Library、Ovid、EBSCO、万方、维普、CNKI、CBM，查找HFNC治疗成人重症免疫抑制患者的随机对照试验。检索时限为建库至2019年5月。同时为了避免遗漏，对纳入文献的参考文献进行手工检索。并采用Revman 5.3软件进行meta分析。结果共纳入8项研究，涉及1 302例患者。Meta分析结果显示，HFNC与传统氧疗相比，能降低患者的插管率［OR=0.77，95%CI（0.60，0.97），Z=2.19，P=0.03］，但与无创通气相比，在降低插管率上差异无统计学意义［OR=0.43，95%CI（0.17，1.08)，Z=1.80，P=0.07］。两个亚组合并结果显示，HFNC较对照氧疗相比，能显著降低重症免疫抑制患者的插管率［合并: OR=0.74，95%CI（0.58，0.93），Z=2.58，P=0.01］，但对降低病死率、感染率及缩短ICU住院时间差异无统计学意义［病死率：OR=0.84，95%CI（0.66，1.08），Z=1.34，P=0.18；感染率：OR=0.80，95%CI（0.56，1.15），Z=1.19，P=0.24；ICU住院时间：OR=-0.19，95%CI（-2.51，2.12），Z=0.16，P=0.87］。而在进行敏感性分析时发现，HFNC与对照氧疗相比，能显著降低患者的ICU住院时间。结论 HFNC与对照氧疗相比，能显著降低患者的插管率，但不能降低患者的病死率及感染率。

关键词: 重症联合免疫缺陷, 呼吸功能不全, 经鼻高流量湿化氧疗, Meta分析

Abstract: Objective To systematically evaluate the efficacy of Highflow nasal cannula oxygen therapy(HFNC) in adult patients with severe immunosuppression.Methods Databases including PubMed, Embase, Cochrane Library, Ovid, EBSCO, WanFang, VIP, CNKI, CBM were searched by computer to collect the RCT studies about the efficacy of HFNC in adult patients with severe immunosuppression.The retrieval time limit was from the establishment of the database to May 2019. In order to avoid omission, the references included in the literature were searched manually. Revman 5.3 software was used for metaanalysis.Results A total of 8 studies involving 1 302 patients were included. Metaanalysis results showed that HFNC could reduce the intubation rate of patients compared with conventional oxygen therapy (OR=0.77, 95%CI ［0.60, 0.97］, Z=2.19, P=0.03), but there was no statistical difference in reducing intubation rate compared with noninvasive ventilation (OR=0.43, 95%CI［0.17, 1.08］, Z=1.80, P=0.07). The results of two subcombinations showed that the intubation rate of severe immunosuppressive patients was significantly reduced by HFNC compared with control oxygen therapy (combination:OR=0.74, 95%CI［0.58, 0.93］, Z=2.58, P=0.01), but there was no significant difference in reducing mortality, infection rate and shortening ICU hospitalization time (case fatality rate: OR=0.84, 95%CI［0.66, 1.08］, Z=1.34, P=0.18, infection rate: OR=0.80, 95%CI［0.56, 1.15］, Z=1.19, P=0.24, ICU hospitalization time: OR=0.19, 95%CI［-2.51, 2.12］, Z=0.16, P=0.87).In sensitivity analysis HFNC could significantly reduce ICU hospitalization time compared with control oxygen therapy.Conclusion Compared with the control oxygen therapy, HFNC can significantly reduce the intubation rate of patients, but it can not reduce the mortality and infection rate of patients.

Key words: severe combined immunodeficiency, respiratory insufficiency, highflow nasal oxygen therapy, metaanalysis

甘婉玲1，徐菊玲1，姚惠萍2，温焕1，陈燕1. 经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2020.02.004.

Gan Wanling1, Xu Juling1, Yao Huiping2, Wen Huan1, Chen Yan1. A metaanalysis: efficacy of highflow nasal cannula oxygen therapy in adult patients with severe immunosuppression[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2020.02.004.

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https://huicui.hebmu.edu.cn/CN/Y2020/V35/I2/116

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经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析

A metaanalysis: efficacy of highflow nasal cannula oxygen therapy in adult patients with severe immunosuppression

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