无创高频振荡通气与经鼻持续气道正压通气作为早产儿拔管后呼吸支持的疗效与安全性Meta分析
Noninvasive high-frequency oscillatory ventilation vs.nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants:a meta-analysis
胡晓芳 1程洁 1侯佳璐 1张敏 1郑卿勇 2王倩 3田金徽 2张志刚 3王杨周1
作者信息
- 1. 长治市人民医院护理部,长治 046000
- 2. 兰州大学循证医学中心,兰州73000
- 3. 兰州大学第一医院重症医学科,兰州 730099
- 折叠
摘要
目的 采用Meta分析的方法比较无创高频振荡通气(noninvasive high-frequency oscillatory ventilation,NHFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)作为早产儿拔管后呼吸支持的有效性与安全性.方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国生物医学文献数据库、中国知网、维普、万方及中华医学期刊全文数据库中将NHFOV与NCPAP作为早产儿拔管后呼吸支持的文献,检索时限为建库至2023年4月30日.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析.结果 最终纳入9篇文献,文献质量评价结果显示,1项研究为A级,8项研究为B级.Meta分析结果显示,与NCPAP相比,NHFOV提高了早产儿撤机成功率(RR=1.33,95％CI 1.20～1.47,P＜0.001),降低了再次插管率(RR=0.41,95％CI 0.25～0.65,P＜0.001),提高了二氧化碳清除率(P＜0.05),缩短了无创通气时间、总用氧时间、住院时间(P＜0.05),降低了支气管肺发育不良、气漏、早产儿视网膜病、鼻外伤、腹胀、呼吸暂停等并发症发生率(P＜0.05).结论 在早产儿拔管后应用NHFOV,能够提高早产儿撤机成功率、缩短无创通气时间、提高二氧化碳清除率并降低相关并发症发生率.
Abstract
Objective To compare the effectiveness and safety of noninvasive high-frequency oscillatory ventilation(NHFOV)vs.nasal continuous positive airway pressure(NCPAP)as post-extubation respiratory support for preterm infants using Meta-analysis method.Methods From the inception to April 30,2023,databases including the Cochrane Library,PubMed,Web of Science,Embase,SinoMed,CNKI,VIP,Wanfang and Chinese medical database were searched on this subject.Literature screening,data extraction and bias risk assessment of included studies were conducted by two reviewers independently.RevMan 5.4 software was used for Meta-analysis.Results A total of 9 randomised controlled trials were eventually included.The literature quality evaluation showed that 1 study was grade A and 8 grade B.Comparing with NCPAP group,NHFOV group had higher success rate of extubation(RR=1.33,95％CI 1.20～1.47,P＜0.001),lower reintubation rate(RR=0.41,95％CI 0.25～0.65,P＜0.001),improved carbon dioxide clearance(P＜0.05),shortened durations of non-invasive ventilation,total oxygen therapy and hospital stay(P＜0.05)and lower incidences of complications including bronchopulmonary dysplasia,air leak,retinopathy of prematurity,nasal trauma,abdominal distension,and apnea(P＜0.05).Conclusions As post-extubation respiratory support for preterm infants,NHFOV can increase the success rate of extubation,shorten the duration of non-invasive ventilation,improve carbon dioxide clearance and reduce the incidences of complications.
关键词
早产儿/拔管后/无创高频振荡通气/经鼻持续气道正压通气Key words
Preterm infant/Extubation/Noninvasive high-frequency oscillatory ventilation/Nasal continuous positive airway pressure引用本文复制引用
出版年
2024
NETL
NSTL
万方数据