中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2014年
2期
161-168
,共8页
孙同文%万有栋%阚全程%杨飞%姚海木%关方霞%张金盈%李凌
孫同文%萬有棟%闞全程%楊飛%姚海木%關方霞%張金盈%李凌
손동문%만유동%감전정%양비%요해목%관방하%장금영%리릉
肺水肿%正压呼吸%病死率
肺水腫%正壓呼吸%病死率
폐수종%정압호흡%병사솔
Pulmonary edema%Positive-pressure respiration%Mortality
目的 探讨无创通气对急性心原性肺水肿(ACPE)患者院内病死率的影响.方法 检索PubMed、Embase、万方、中国期刊网数据库1980年1月至2012年12月无创通气治疗ACPE的英文和中文临床随机对照试验,按纳入与排除标准选择文献,提取资料.采用RevMan 5.1软件对数据进行荟萃分析.结果 共纳入35篇随机对照试验,3 204例患者.荟萃分析显示:与常规治疗比较,ACPE患者行持续正压通气(CPAP)可降低43％的院内病死率(RR =0.57,95％ CI 0.43 ～0.75,P＜0.01),双水平正压通气(BiPAP)可降低31％的院内病死率(RR =0.69,95％ CI 0.51 ～0.94,P=0.02).BiPAP在降低院内病死率方面与CPAP比较差异无统计学意义(RR=1.09,95％ CI 0.80 ～1.49,P=0.57),且不增加心肌梗死事件(BiPAP与CPAP比较:RR =1.20,95％ CI 0.95 ～ 1.52,P=0.13；BiPAP与常规治疗比较:RR=1.10,95％ CI 0.88 ～ 1.38,P=0.40).结论 无创通气可以降低ACPE患者的院内病死率,可以作为一线治疗措施.
目的 探討無創通氣對急性心原性肺水腫(ACPE)患者院內病死率的影響.方法 檢索PubMed、Embase、萬方、中國期刊網數據庫1980年1月至2012年12月無創通氣治療ACPE的英文和中文臨床隨機對照試驗,按納入與排除標準選擇文獻,提取資料.採用RevMan 5.1軟件對數據進行薈萃分析.結果 共納入35篇隨機對照試驗,3 204例患者.薈萃分析顯示:與常規治療比較,ACPE患者行持續正壓通氣(CPAP)可降低43％的院內病死率(RR =0.57,95％ CI 0.43 ～0.75,P＜0.01),雙水平正壓通氣(BiPAP)可降低31％的院內病死率(RR =0.69,95％ CI 0.51 ～0.94,P=0.02).BiPAP在降低院內病死率方麵與CPAP比較差異無統計學意義(RR=1.09,95％ CI 0.80 ～1.49,P=0.57),且不增加心肌梗死事件(BiPAP與CPAP比較:RR =1.20,95％ CI 0.95 ～ 1.52,P=0.13；BiPAP與常規治療比較:RR=1.10,95％ CI 0.88 ～ 1.38,P=0.40).結論 無創通氣可以降低ACPE患者的院內病死率,可以作為一線治療措施.
목적 탐토무창통기대급성심원성폐수종(ACPE)환자원내병사솔적영향.방법 검색PubMed、Embase、만방、중국기간망수거고1980년1월지2012년12월무창통기치료ACPE적영문화중문림상수궤대조시험,안납입여배제표준선택문헌,제취자료.채용RevMan 5.1연건대수거진행회췌분석.결과 공납입35편수궤대조시험,3 204례환자.회췌분석현시:여상규치료비교,ACPE환자행지속정압통기(CPAP)가강저43％적원내병사솔(RR =0.57,95％ CI 0.43 ～0.75,P＜0.01),쌍수평정압통기(BiPAP)가강저31％적원내병사솔(RR =0.69,95％ CI 0.51 ～0.94,P=0.02).BiPAP재강저원내병사솔방면여CPAP비교차이무통계학의의(RR=1.09,95％ CI 0.80 ～1.49,P=0.57),차불증가심기경사사건(BiPAP여CPAP비교:RR =1.20,95％ CI 0.95 ～ 1.52,P=0.13；BiPAP여상규치료비교:RR=1.10,95％ CI 0.88 ～ 1.38,P=0.40).결론 무창통기가이강저ACPE환자적원내병사솔,가이작위일선치료조시.
Objective To evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema (ACPE).Methods We searched PubMed,Embase,Wanfang,CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE,which were reported from January 1980 to December 2012.Meta-analysis was performed with software of RevMan 5.1.Results According to inclusive criteria and exclusion criteria,35 randomized controlled trials with 3 204 patients were enrolled for analyses.Meta-analysis of the trials showed that continuous positive airway pressure (CPAP) reduced in-hospital mortality by 43％ (RR =0.57,95％ CI 0.43-0.75,P ＜ 0.01) and bilevel positive pressure ventilation (BiPAP) reduced mortality by 31％ (RR =0.69,95 ％ CI 0.51-0.94,P =0.02) compared with standard therapy.There were no significant differences in in-hospital mortality between BiPAP and CPAP(RR =1.09,95 ％ CI 0.80-1.49,P =0.57) and myocardial infarction rate(BiPAP vs.CPAP:RR =1.20,95％ CI 0.95-1.52,P =0.12; BiPAP vs.standard therapy:RR =1.10,95％ CI 0.88-1.38,P =0.40).Conclusion Noninvasive ventilation (BiPAP and CPAP) could reduce in-hospital mortality of adult patients with ACPE,which could be used as first-line management strategies for these patients.
