中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
4期
360-365
,共6页
郭凤梅%刘松桥%杨从山%杨毅%邱海波
郭鳳梅%劉鬆橋%楊從山%楊毅%邱海波
곽봉매%류송교%양종산%양의%구해파
无创正压通气%急性呼吸衰竭%病死率%荟萃分析
無創正壓通氣%急性呼吸衰竭%病死率%薈萃分析
무창정압통기%급성호흡쇠갈%병사솔%회췌분석
Noninvasive positive pressure ventilation%Acute respiratory failure%Mortality%Meta
目的 探讨无创正压通气对急性呼吸衰竭患者拔管后再插管率和预后的影响.方法 通过计算机检索和手工检索中文期刊数据库,Pubmed,Embase,Web of Science数据库,收集1995年1月1日至2010年6月30日关于无创正压通气对急性呼吸衰竭患者拔管后进行呼吸支持和治疗的随机对照研究,按Cochrane协作网推荐的方法对拔管后采用无创正压通气进行呼吸辅助治疗患者的再插管率和病死率行Meta评价.结果 共纳入6篇随机对照研究,其中拔管后无创正压通气组(治疗组)患者381例,拔管后常规氧疗组(对照组)患者379例,治疗组和对照组患者的病死率分别为18.6%(62/334)vs.21.6%(72/333)(P=0.34),再插管率分别为30.2%(115/381)vs.33.5%(127/379)(P=0.27).与常规氧疗相比,拔管后无创正压通气不能降低患者再插管率,也不能改善患者预后.对拔管后即开始进行无创正压通气的患者进行分析,结果提示治疗组患者病死率明显降低[12.2%(22/181)vs.23.9%(44/184),P=0.004],再插管率减少;但与对照组相比,差异无统计学意义[14.0%(32/228)vs.20.4%(47/230),P=0.07].结论 急性呼吸衰竭患者拔管后早期行无创正压通气有助于减少患者再插管率,可显著改善患者预后.
目的 探討無創正壓通氣對急性呼吸衰竭患者拔管後再插管率和預後的影響.方法 通過計算機檢索和手工檢索中文期刊數據庫,Pubmed,Embase,Web of Science數據庫,收集1995年1月1日至2010年6月30日關于無創正壓通氣對急性呼吸衰竭患者拔管後進行呼吸支持和治療的隨機對照研究,按Cochrane協作網推薦的方法對拔管後採用無創正壓通氣進行呼吸輔助治療患者的再插管率和病死率行Meta評價.結果 共納入6篇隨機對照研究,其中拔管後無創正壓通氣組(治療組)患者381例,拔管後常規氧療組(對照組)患者379例,治療組和對照組患者的病死率分彆為18.6%(62/334)vs.21.6%(72/333)(P=0.34),再插管率分彆為30.2%(115/381)vs.33.5%(127/379)(P=0.27).與常規氧療相比,拔管後無創正壓通氣不能降低患者再插管率,也不能改善患者預後.對拔管後即開始進行無創正壓通氣的患者進行分析,結果提示治療組患者病死率明顯降低[12.2%(22/181)vs.23.9%(44/184),P=0.004],再插管率減少;但與對照組相比,差異無統計學意義[14.0%(32/228)vs.20.4%(47/230),P=0.07].結論 急性呼吸衰竭患者拔管後早期行無創正壓通氣有助于減少患者再插管率,可顯著改善患者預後.
목적 탐토무창정압통기대급성호흡쇠갈환자발관후재삽관솔화예후적영향.방법 통과계산궤검색화수공검색중문기간수거고,Pubmed,Embase,Web of Science수거고,수집1995년1월1일지2010년6월30일관우무창정압통기대급성호흡쇠갈환자발관후진행호흡지지화치료적수궤대조연구,안Cochrane협작망추천적방법대발관후채용무창정압통기진행호흡보조치료환자적재삽관솔화병사솔행Meta평개.결과 공납입6편수궤대조연구,기중발관후무창정압통기조(치료조)환자381례,발관후상규양료조(대조조)환자379례,치료조화대조조환자적병사솔분별위18.6%(62/334)vs.21.6%(72/333)(P=0.34),재삽관솔분별위30.2%(115/381)vs.33.5%(127/379)(P=0.27).여상규양료상비,발관후무창정압통기불능강저환자재삽관솔,야불능개선환자예후.대발관후즉개시진행무창정압통기적환자진행분석,결과제시치료조환자병사솔명현강저[12.2%(22/181)vs.23.9%(44/184),P=0.004],재삽관솔감소;단여대조조상비,차이무통계학의의[14.0%(32/228)vs.20.4%(47/230),P=0.07].결론 급성호흡쇠갈환자발관후조기행무창정압통기유조우감소환자재삽관솔,가현저개선환자예후.
Objective To evaluate the effects of noninvasive positive pressure ventilation (NPPV)used after extubation on mortality and rate of reintubation in patients with acute respiratory failure (ARF).Method Pubmed, Embase, Web of Science databases were searched to collect data from randomized controlled trials (RCT) of the relevant subject from January 1995 to May 2010. Meta analysis of data about NPPV on mortality and rate of reintubation in patients after extubation carried out by using the methods recommended by the Cochrane Collaboration. Results Six RCTs included sample size of 381 NPPV and 379routine medical care. In total, the mortalities of patients in NPPV group and routine medical care group were 18.6% (62/334) vs. 21.6% (72/333), respectively, and the rates of reintubation of the two groups were 30.2% (115/381) vs. 33.5% (127/379), respectively. Compared with routine medical care, NPPV did not significantly reduce the mortality ( OR: 0.83, 95% CI =0.57 ～ 1.21 ,P =0.34) and rate of reintuation( OR: 0.83, 95% CI = 0.59 ～ 1.16, ( P = 0.27). When the analysis was focused to the four studies of them in which patients received NPPV as soon as extubation, the results were quite different. From these four studies, the mortalities of patients in NPPV group and routine medical care group were 12. 2% (22/181) vs.23.9% (44/184),(P=0.004), and the rate of reintubation of the two groups were 14.0% (32/228) vs.20.4% (47/230), (P =0.07). Compared with routine medical care, early application of NPPV to patients after extubation reduced the mortality. Conclusions This study suggests the favorable effects of early application of NPPV to patients after extubation on the mortality of acute respiratory failure.
