CAJ | 학술논문

目的评价无创双水平正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性加重(AECOPD)并发肺性脑病(PE)的效果.方法计算机检索Pubmed、ISI Web of knowledge、中国生物医学文献数据库、中国知网期刊数据库、万方资源数据库,收集国内外发表的关于BiPAP通气联合纳洛酮治疗AECOPD并发PE的相关文献,并按照纳入标准和排除标准筛选初步入选的随机对照实验(RCT).进行质量评价后,提取有效数据并利用RevMan 5.2软件进行meta分析.结果共纳入10篇RCT文献,包括697例患者(试验组353例,对照组343例),系统评价结果表明:BiPAP联合纳洛酮治疗有助于提高AECOPD合并PE患者的PaO2[WMD =4.10,95％ CI (2.83,5.38),P＜0.00001]、pH值[WMD =0.04,95％ CI (0.02,0.05),P＜0.00001]及临床有效率[OR=3.58,95％ CI(2.22,5.76),P＜0.00001],降低PaCO2[WMD=-5.78,95％CI(-6.87,4.69),P＜0.00001]、再插管率[OR=0.19,95％ CI (0.11,0.35),P＜0.00001].但不能有效降低死亡率[OR=0.38,95％ CI(0.11,1.34),P=0.13].结论 BiPAP联合纳洛酮治疗AECOPD并发PE可以改善患者血气指标,提高临床疗效,降低再插管率,但不能有效降低死亡率.
목적 평개무창쌍수평정압통기연합납락동치료만성조새성폐질병급성가중(AECOPD)병발폐성뇌병(PE)적효과.방법 계산궤검색Pubmed、ISI Web of knowledge、중국생물의학문헌수거고、중국지망기간수거고、만방자원수거고,수집국내외발표적관우BiPAP통기연합납락동치료AECOPD병발PE적상관문헌,병안조납입표준화배제표준사선초보입선적수궤대조실험(RCT).진행질량평개후,제취유효수거병이용RevMan 5.2연건진행meta분석.결과 공납입10편RCT문헌,포괄697례환자(시험조353례,대조조343례),계통평개결과표명:BiPAP연합납락동치료유조우제고AECOPD합병PE환자적PaO2[WMD =4.10,95％ CI (2.83,5.38),P＜0.00001]、pH치[WMD =0.04,95％ CI (0.02,0.05),P＜0.00001]급림상유효솔[OR=3.58,95％ CI(2.22,5.76),P＜0.00001],강저PaCO2[WMD=-5.78,95％CI(-6.87,4.69),P＜0.00001]、재삽관솔[OR=0.19,95％ CI (0.11,0.35),P＜0.00001].단불능유효강저사망솔[OR=0.38,95％ CI(0.11,1.34),P=0.13].결론 BiPAP연합납락동치료AECOPD병발PE가이개선환자혈기지표,제고림상료효,강저재삽관솔,단불능유효강저사망솔.
Objective To review the effect of non-invasive bi-level positive airway pressure ventilation combined with naloxone in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy (PE).Methods Related published studies involving BiPAP combined with naloxone in the treatment of AECOPD complicated with PE were recruited and identified from Pubmed,ISI Web of knowledge,CBM Disc,CNKI,Wanfang Data,and randomized controlled trails(RCTs) primarily collected were screened according to inclusive criteria and exclusive criteria.Valid data were extracted after quality evaluation for meta-analysis utilizing RevMan 5.2.Results A total of 10 Chinese RCTs were enrolled,including 697 patients (353 patients in experimental group while 343 patients in control group).The results of metaanalysis indicated that BiPAP combined with naloxone improved PaO2 (WMD =4.10,95％ CI (2.83,5.38),P＜0.00001),PH value(WMD =0.04,95％ CI (0.02,0.05),P ＜ 0.00001) and clinical efficiency rate (OR =3.58,95 ％ CI ((2.22,5.76),P ＜ 0.00001),and reduced PaCO2 (WMD =-5.78,95 ％ CI (-6.87,4.69),P ＜ 0.00001),re-endotracheal intubation rate (OR =0.19,95 ％ CI (0.11,0.35),P ＜ 0.00001),but failed to decrease mortality(OR =0.38,95％ CI (0.11,1.34),P =0.13) of patients with AECOPD complicated with PE.Conclusions BiPAP combined with naloxone play a protective role in enhancing arterial blood gas indexes,improving clinical efficiency rate and limiting re-endotracheal intubation rate.However,the mortality of patients cannot be reduced.