国内重症监护病房应用无创呼吸机治疗急性心力衰竭合并呼吸衰竭疗效的Meta分析

Effect of noninvasive ventilator in treatment of acute heart failure combined with respiratory failure in ICU ward of China: meta-analysis

摘要:

目的  通过Meta分析的方法对国内重症监护病房应用无创呼吸机正压通气治疗急性心力衰竭合并呼吸衰竭（AHFRF）的临床疗效进行系统评价。方法  计算机检索维普科技期刊数据库（1989～2015年）、万方数据库（1999～2015年）、中国知网（1994～2015年）、中国学术期刊网络出版总库中，关于无创呼吸机正压通气治疗AHFRF的临床随机对照试验（RCT），对符合要求的RCT进行Meta分析。结果  24篇RCT，共1 779例患者符合纳入标准。Meta分析结果显示，较常规治疗组比较，无创呼吸机正压通气治疗AHFRF患者心率[总效应Z =7.69，MD=-20.82，95%CI（-26.13，-15.15）P =0.000]、呼吸频率[总效应Z=21.61，MD=-6.56，95%CI（-7.16，-5.97）P =0.000]及死亡率[总效应Z=2.95，■=0.33，95%CI（0.16，0.69）P =0.003]降低更显著，且血氧饱和度[总效应Z =9.01，MD=0.07，95%CI（0.05，0.08）P =0.000]、临床有效率[总效应Z =8.56，MD=4.89，95%CI（3.40，7.03）P =0.000]显著提高。结论  在常规治疗的基础上，采用无创呼吸机正压通气治疗AHFRF能显著改善患者的心肺功能，降低死亡率，临床疗效确切。

Abstract:

Objective To carry out a meta-analysis on the published data in order to evaluate the therapeutic effect of noninvasive positive pressure ventilation on acute heart failure combined with respiratory failure (AHFRF). Methods A comprehensive search was performed in VIP (1989-2015), WANFANG (1999-2015), CNKI (1994-2015) and CAJD databases to collect the randomized controlled trials (RCTs) about noninvasive positive pressure ventilation in the treatment of AHFRF, and to analyze the RCTs using a meta-analysis method. Results A total of 1,779 patients were analyzed in the 24 RCTs which met the inclusion criteria. The meta-analysis results suggested that, compared with the conventional therapy group, the patients in the noninvasive positive pressure ventilation group had slower heart rate [test for overall effect: Z = 7.69, MD = -20.82, 95% CI (-26.13, -15.15), P = 0.000], slower respiratory rate [test for overall effect: Z = 21.61, MD = -6.56, 95% CI (-7.16, -5.97), P = 0.000], lower mortality rate [test for overall effect: Z = 2.95, ■= 0.33, 95% CI (0.16, 0.69), P = 0.003], higher blood oxygen saturation [test for overall effect: Z = 9.01, MD = 0.07, 95% CI (0.05, 0.08) P = 0.000] and clinical effective rate [test for overall effect: Z = 8.56, MD = 4.89, 95% CI (3.40, 7.03) P = 0.000]. Conclusions On the basis of conventional therapy, noninvasive positive pressure ventilation can significantly improve cardiorespiratory function and reduce mortality, and has definite  clinical efficacy in the treatment of acute heart failure combined with respiratory failure.