论文部分内容阅读
目的系统评价加热湿化高流量鼻导管辅助通气(HHHFNC)与经鼻持续气道正压通气(NCPAP)比较治疗新生儿呼吸窘迫综合征(NRDS)的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2017年3期)、CBM、VIP、Wan Fang Data和CNKI数据库,搜集HHHFNC与NCPAP比较治疗NRDS的随机对照试验(RCT),检索时限均从建库至2017年3月27日。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入11个研究,1 104例患者。Meta分析结果显示:(1)HHHFNC组能降低NRDS患儿重新插管率[OR=0.56,95%CI(0.32,0.98),P=0.04],缩短辅助通气时间[MD=–11.12,95%CI(–13.31,–8.93),P<0.000 01]、住院时间[MD=–2.99,95%CI(–3.54,–2.44),P<0.000 01]及开奶时间[MD=–17.82,95%CI(–21.19,–14.45),P<0.000 01],降低48小时动脉二氧化碳分压[MD=–4.86,95%CI(–5.94,–3.78),P<0.000 01]。HHHFNC组的气漏[OR=0.32,95%CI(0.12,0.90),P=0.03]、腹胀[OR=0.17,95%CI(0.09,0.30),P<0.000 01]、鼻损伤[OR=0.08,95%CI(0.03,0.20),P<0.000 01]、头部塑形[OR=0.03,95%CI(0.00,0.23),P=0.000 7]的发生率均低于NCPAP组,其差异均有统计学意义。(2)HHHFNC组与NCPAP组在病死率、院内感染率、氧暴露时间、48小时动脉氧分压及血氧饱和度及脑室内出血(IVH)、动脉导管未闭(PDA)、早产儿视网膜病(ROP)、支气管肺发育不良(BPD)、新生儿坏死性小肠结肠炎(NEC)的发生率方面,差异均无统计学意义。结论现有证据表明,HHHFNC能降低NRDS的重新插管率,缩短辅助通气时间、住院时间及开奶时间,降低48小时动脉二氧化碳分压,并且降低气漏、腹胀、鼻损伤、头部塑形的发生率。受纳入研究数量和质量限制,有关HHHFNC对NRDS的远期疗效仍有待大规模、多中心的RCT予以验证。
Objective To evaluate the efficacy and safety of heating-humidifying high-flow nasal catheter assisted ventilation (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods The randomized controlled trials (RCTs) comparing HHHFNC with NCPAP in the treatment of NRDS were collected from PubMed, EMbase, The Cochrane Library (2017), CBM, VIP, Wan Fang Data and CNKI database. Until March 27, 2017. After two reviewers independently screened the literature, extracted data, and assessed the risk of being included in the study, Meta-analysis was performed using Rev Man 5.3 software. Results A total of 11 studies were included and 1,104 patients were included. Meta-analysis showed that: (1) HHHFNC group can reduce the re-intubation rate of NRDS children [OR = 0.56,95% CI (0.32,0.98, P = 0.04] and shorten the time of assisted ventilation [MD = -11.12, 95% CI -13.31, -8.93, P <0.000 01], hospital stay [MD = -2.99,95% CI (-3.54, -2.44), P <0.000 01] and openning time [MD = -17.82,95 % CI (-21.19, -14.45), P <0.000 01], lower arterial partial pressure of carbon dioxide for 48 hours [MD = -4.86, 95% CI (-5.94, -3.78), P <0.000 01]. Gas leak in the HHHFNC group [OR = 0.32, 95% CI (0.12, 0.90), P = 0.03], bloating [OR = 0.17, 95% CI (0.09, 0.30), P <0.000 01] (OR = 0.03,95% CI (0.00,0.23), P = 0.0007] were lower than those in the NCPAP group (P <0.000 01) The differences were statistically significant. (2) There was no significant difference in mortality, nosocomial infection rate, oxygen exposure time, arterial oxygen pressure and oxygen saturation at 48 hours, IVH, PDA, retinopathy of prematurity in HHHFNC group and NCPAP group ROP, BPD and NEC were not statistically significant. Conclusions The available evidence shows that HHHFNC can reduce the re-intubation rate of NRDS, shorten the time of auxiliary ventilation, hospital stay and the time of opening milk, reduce the partial pressure of arterial carbon dioxide for 48 hours, and reduce air leakage, abdominal distension, nasal injury and head shaping The incidence of. Long-term efficacy of HHHFNC on NRDS remains to be validated by large, multicenter RCTs, due to the number and quality of studies included.