摘要
目的分析有创–无创序贯机械通气对慢性阻塞性肺疾病(简称慢阻肺)合并呼吸衰竭患者的治疗效果。方法计算机检索Pub Med、The Cochrane Library、Embase、中国生物医学数据库、中国知网、万方数据库。纳入使用有创–无创序贯机械通气治疗慢阻肺合并呼吸衰竭患者的随机对照试验。结果该Meta分析包括了553个研究对象在内的11项研究。结果显示有创–无创序贯机械通气降低了死亡率[RR=0.37,95%CI(0.22~0.61),P=0.0001]、呼吸机相关性肺炎(VAP)发生率[RR=0.20,95%CI(0.13~0.32),P<0.00001]、再插管率[R R=0.40,95%C I(0.23~0.68),P=0.0008],缩短了有创机械通气时间[M D=–10.47,95%CI(–13.80~–7.14),P<0.00001]、机械通气时间[MD=–4.54,95%CI(–7.01~–2.06),P=0.0003]、重症加强治疗病房(ICU)住院时间[MD=–8.75,95%CI(–13.49~–4.01),P=0.0003]和总住院时间[MD=–9.11,95%CI(–11.68~–6.55),P<0.00001],差异均有统计学意义。结论有创–无创序贯机械通气能显著降低慢阻肺合并呼吸衰竭患者的VAP发生率,显著缩短有创机械通气时间和总住院时间,可降低死亡率和再插管率,缩短机械通气时间和ICU住院时间,治疗效果较好。
Objective To analyze the treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease(COPD)patients with respiratory failure.Methods A review of randomized controlled trials with meta-analysis performed by searching databases of Pub Med,the Cochrane Library,Embase,Chinese Bio Medical Literature Database,China National Knowledge Infrastructure,and Wan Fang data.Randomized controlled trials by using sequential noninvasive following invasive mechanical ventilation in COPD patients with respiratory failure were eligible for inclusion.Results Eleven trials were included,involving 553 COPD patients with respiratory failure.Meta-analysis showed that sequential noninvasive following invasive mechanical ventilation reduced the mortality rate[RR=0.37,95%CI(0.22 to 0.61),P=0.0001],the incidence of ventilator-associated pneumonia(VAP)[RR=0.20,95%CI(0.13 to 0.32),P<0.00001],reintubation rate[RR=0.40,95%CI(0.23 to 0.68),P=0.0008];it also decreased the duration of invasive mechanical ventilation[MD=–10.47,95%CI(–13.80 to–7.14),P<0.00001]and duration of mechanical ventilation[MD=–4.54,95%CI(–7.01 to–2.06),P=0.0003],which also shortened the lengths of stay in an intensive care unit(ICU)[MD=–8.75,95%CI(–13.49 to–4.01),P=0.0003],as well as length of hospital stay[MD=–9.11,95%CI(–11.68 to–6.55),P<0.00001].Conclusion Sequential noninvasive following invasive mechanical ventilation can significantly reduce the incidence of VAP,the duration of invasive mechanical ventilation,the length of hospital stay in COPD patients with respiratory failure,and reduce the mortality,reintubation rate,the duration of mechanical ventilation and the length of ICU stay as well.
作者
杨琳
姚丽
张志刚
丁楠楠
张彩云
杨丽平
岳伟岗
李娜
田金徽
YANG Lin;YAO Li;ZHANG Zhigang;DING Nannan;ZHANG Caiyun;YANG Liping;YUE Weigang;LI Na;TIAN Jinhui(School of Nursing,Lanzhou University,Lanzhou,Gansu 730000,P.R.China;The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,P.R.China;Evidence-based Medicine Center,Lanzhou University,Lanzhou,Gansu 730000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2020年第4期351-358,共8页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
机械通气
序贯通气
慢性阻塞性肺疾病
呼吸衰竭
META分析
Mechanical ventilation
Sequential ventilation
Chronic obstructive pulmonary disease
Respiratory failure
Meta-analysis
