家庭无创正压机械通气治疗慢性阻塞性肺疾病及其合并呼吸衰竭效果的Meta分析
|
摘要
[目的]系统评价家庭无创正压机械通气在慢性阻塞性肺疾病(COPD)及其合并呼吸衰竭病人中的应用效果。[方法]计算机检索万方数据库、中国知网、中国生物医学文献数据库、PubMed、Cochrane Library、Web of science数据库,检索时间均从建库至2017年1月,搜集有关家庭无创正压机械通气应用于COPD及COPD合并呼吸衰竭病人的随机对照试验,采用RevMan 5.3软件进行Meta分析。[结果]共纳入21项随机对照试验,共1 437例病人。Meta分析结果显示:家庭无创正压机械通气可以提高病人的动脉血氧分压[MD=8.47,95%CI(7.19,9.76),P<0.000 01]和一秒用力呼气容积[MD=0.09,95%CI(0.08,0.10),P<0.000 01],降低病人动脉血二氧化碳分压[MD=-9.01,95%CI(-10.25,-7.77),P<0.000 01],减少病人年住院次数[MD=-2.44,95%CI(-2.93,-1.95),P<0.000 01]及住院费用[MD=-0.39,95%CI(-0.62,-0.15),P=0.001]。[结论]现有证据表明,家庭无创正压机械通气可以有效改善COPD及COPD合并呼吸衰竭病人缺氧状况,促进病人康复,减轻病人经济负担。但受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective:To evaluate the application effect of family non-invasive positive pressure ventilation for patients with chronic obstructive pulmonary disease and its combined with respiratory failure.Method:Databases including Wanfang Data,CNKI,CBM,PubMed,Cochrane Library,Web of Science were searched electronically from inception to January 2017 to collect the randomized controlled trials(RCTs)about family non-invasive positive pressure ventilation for patients with COPD and its combined with respiratory failure.Meta analysis was performed using RevMan 5.3 software.Results:A total of 21 RCTs were included involving 1 437 cases.Meta analysis showed that family non-invasive positive pressure ventilation could improve arterial oxygen partial pressure[MD=8.47,95%CI(7.19,9.76),P<0.000 01]and one second forced expiratory volume[MD=0.09,95%CI(0.08,0.10),P<0.000 01],reduce arterial partial pressure of carbon dioxide[MD=-9.01,95%CI(-10.25,-7.77),P<0.000 01],number of annual hospitalization[MD=-2.44,95%CI(-2.93,-1.95),P<0.000 01]and hospitalization expenses[MD=-0.39,95%CI(-0.62,-0.15),P=0.001].Conclusion:Present evidences showed that family non-invasive positive pressure ventilation could improve condition of hypoxia,promote the rehabilitation and reduce the economic burden of the patients.But it was limited by the quality and quantity of included researches so it needs to be verified by the high quality researches.
Objective:To evaluate the application effect of family non-invasive positive pressure ventilation for patients with chronic obstructive pulmonary disease and its combined with respiratory failure.Method:Databases including Wanfang Data,CNKI,CBM,PubMed,Cochrane Library,Web of Science were searched electronically from inception to January 2017 to collect the randomized controlled trials(RCTs)about family non-invasive positive pressure ventilation for patients with COPD and its combined with respiratory failure.Meta analysis was performed using RevMan 5.3 software.Results:A total of 21 RCTs were included involving 1 437 cases.Meta analysis showed that family non-invasive positive pressure ventilation could improve arterial oxygen partial pressure[MD=8.47,95%CI(7.19,9.76),P<0.000 01]and one second forced expiratory volume[MD=0.09,95%CI(0.08,0.10),P<0.000 01],reduce arterial partial pressure of carbon dioxide[MD=-9.01,95%CI(-10.25,-7.77),P<0.000 01],number of annual hospitalization[MD=-2.44,95%CI(-2.93,-1.95),P<0.000 01]and hospitalization expenses[MD=-0.39,95%CI(-0.62,-0.15),P=0.001].Conclusion:Present evidences showed that family non-invasive positive pressure ventilation could improve condition of hypoxia,promote the rehabilitation and reduce the economic burden of the patients.But it was limited by the quality and quantity of included researches so it needs to be verified by the high quality researches.
引文
[1]吴海珊,许光兰,雷蓓,等.缺氧对肺心病患者肺动脉压力以及右心室结构与功能的影响[J].中西医结合心脑血管病杂志,2012,10(8):927-928.
[2]贾恩霞,刘伟,赵亚.家庭氧疗对农村肺心病患者预后及生活质量的影响[J].实用临床医药杂志,2018,22(1):136-138;142.
[3]李芬,罗琦.OSAS老年患者的便携式睡眠监测产品设计研究[D].北京:北京理工大学,2015:1-60.
[4]李俊红,阿布都外里,阿布都乃比,等.微创冠状动脉旁路移植术与经皮冠状动脉介入术治疗前降支近端单支病变疗效的Meta分析[J].中国循证医学,2016,16(6):698-705.
[5]郭新玲.家庭使用BIPAP呼吸机治疗慢阻肺合并呼吸衰竭的疗效观察[J].中国社区医师(医学专业),2013,15(6):56.
[6]陈建丽,徐超.家庭无创呼吸机对稳定期COPD并慢性呼吸衰竭的疗效观察[J].医药论坛杂志,2014,35(3):84-85.
[7]黎月莲.家庭应用无创呼吸机治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭的临床研究[J].广西医学,2016,38(2):282-284.
[8]刘海霞,孙德凤,陈玉兰,等.家庭应用无创呼吸机治疗稳定期重度COPD患者的适用性研究[J].临床肺科杂志,2012,17(4):739-740.
[9]徐左平,稽立兵.家用无创正压机械通气治疗稳定期重度慢性阻塞性肺疾病患者的疗效观察[J].实用心脑肺血管病杂志,2012,20(2):337-338.
[10]毛苏萍,吴春玲,陈成水,等.老年慢性阻塞性肺病合并呼吸衰竭患者家庭无创呼吸机应用疗效及依从性[J].中国老年学杂志,2015,35(23):6802-6804.
[11]张永红,刘红红,李爱军,等.无创正压通气治疗稳定期COPD的临床疗效观察[J].热带医学杂志,2014,14(10):1316-1317;1346.
[12]高秀玲,孔君.家庭无创正压通气治疗慢性阻塞性肺病稳定期的疗效分析[J].中国社区医师(医学专业),2011,13(30):27.
[13]孙春娟,王文明.长期家庭无创正压通气对严重COPD稳定期的疗效观察[J].内蒙古医学杂志,2010,42(10):1262-1263.
[14]刘姣艳.家庭无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭急性加重疗效的分析[J].医学美学美容,2014(12):166-167.
[15]李航,王臣玉,初美华,等.家庭无创正压机械通气治疗稳定期重度慢性阻塞性肺疾病患者的临床研究[J].中华结核和呼吸杂志,2011,34(7):540-542.
[16]邹从胜.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的应用与观察[J].医学信息,2015,28(12):217-218.
[17]热西汗·依不拉音,夏迪亚·夏木西丁.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察[J].当代医学,2012(33):105-106.
[18]杨红萍,洪哲云.慢性阻塞性肺疾病患者应用家庭无创通气的护理[J].中华医院感染学杂志,2011,21(2):267-269.
[19]苏爱峰.院外无创呼吸机治疗慢性阻塞性肺疾病稳定期的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(4):121-123.
[20]陈鹃.家庭无创通气治疗慢性阻塞性肺疾病的护理[J].中国社区医师(医学专业),2013,15(1):280-281.
[21]林国勇.长期无创正压通气在稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的应用价值[J].现代诊断与治疗,2015,26(20):4752-4754.
[22]王斌.慢性阻塞性肺疾病患者家庭应用无创机械通气疗效观察[J].临床合理用药杂志,2014,7(7):19-20.
[23]孟令儒,戚应静,陈卫民,等.慢性阻塞性肺疾病合并慢性呼吸衰竭患者长期家庭无创通气64例临床观察[J].中国医疗前沿,2009,4(7):85-86.
[24]叶创新.无创双水平正压通气治疗重度-极重度慢性阻塞性肺疾病稳定期的效果观察[J].现代诊断与治疗,2014,25(24):5718-5719.
[25]郑晓璐,李明生,魏厚华,等.家庭双水平无创正压机械通气对稳定期极重度COPD患者的疗效观察[J].中国医药导报,2012,9(1):132-134.
[26]Halbert RJ,Natoli JL,Gano A,et al.Global burden of COPD:systematic review and meta-analysis[J].Eur Respir J,2006,28(3):523-532.
[27]董卫平.长期家庭氧疗对慢性阻塞性肺疾病合并慢性肺源性心脏病患者肺动脉高压和高黏血症的影响[J].中国呼吸与危重监护杂志,2006,5(3):185-188.
[28]陈英华,张立军.BiPAP无创呼吸机联合呼吸兴奋剂治疗COPD合并Ⅱ型呼衰的疗效观察[J].临床肺科杂志,2015,20(2):297-299.
[29]余静.无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效[J].中华临床医师杂志,2016,10(4):216.
[30]韩利红.BiPAP无创呼吸机对重度COPD合并慢性呼吸衰竭患者的疗效分析[D].郑州:郑州大学,2016:1-52.
[31]陈宏,尚愚,于方飞,等.家庭应用无创机械通气对COPD患者肺功能及医疗费用的影响[J].现代生物医学进展,2013,12(13):2325-2327.
[32]Seetho IW,Asher R,Parker RJ,et al.Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnoea[J].Sleep Breath,2015,19(4):1155-1165.
[33]万小兵,陈宇洁,陆海英.无创呼吸机辅助治疗老年慢性阻塞性肺疾病合并呼吸衰竭的临床效果研究[J].实用心脑肺血管病杂志,2015,23(9):96-98.
[34]Skomro RP,Gjevre J,Reid J,et al.Outcomes of homebased diagnosis and treatment of obstructive sleep apnea[J].Chest,2010,138(2):257-263.
[35]Damjanovic D,Fluck A,Bremer H,et al.Compliance in sleep apnoea therapy:influence of home care support and pressure mode[J].Eur Respir J,2009,33(4):804-811.
[36]Richards D,Bartlett DJ,Wong K,et al.Increased adherence to CPAP with a group cognitive behavioral treatment intervention:a randomized trial[J].Sleep,2007,30(5):635-640.
[2]贾恩霞,刘伟,赵亚.家庭氧疗对农村肺心病患者预后及生活质量的影响[J].实用临床医药杂志,2018,22(1):136-138;142.
[3]李芬,罗琦.OSAS老年患者的便携式睡眠监测产品设计研究[D].北京:北京理工大学,2015:1-60.
[4]李俊红,阿布都外里,阿布都乃比,等.微创冠状动脉旁路移植术与经皮冠状动脉介入术治疗前降支近端单支病变疗效的Meta分析[J].中国循证医学,2016,16(6):698-705.
[5]郭新玲.家庭使用BIPAP呼吸机治疗慢阻肺合并呼吸衰竭的疗效观察[J].中国社区医师(医学专业),2013,15(6):56.
[6]陈建丽,徐超.家庭无创呼吸机对稳定期COPD并慢性呼吸衰竭的疗效观察[J].医药论坛杂志,2014,35(3):84-85.
[7]黎月莲.家庭应用无创呼吸机治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭的临床研究[J].广西医学,2016,38(2):282-284.
[8]刘海霞,孙德凤,陈玉兰,等.家庭应用无创呼吸机治疗稳定期重度COPD患者的适用性研究[J].临床肺科杂志,2012,17(4):739-740.
[9]徐左平,稽立兵.家用无创正压机械通气治疗稳定期重度慢性阻塞性肺疾病患者的疗效观察[J].实用心脑肺血管病杂志,2012,20(2):337-338.
[10]毛苏萍,吴春玲,陈成水,等.老年慢性阻塞性肺病合并呼吸衰竭患者家庭无创呼吸机应用疗效及依从性[J].中国老年学杂志,2015,35(23):6802-6804.
[11]张永红,刘红红,李爱军,等.无创正压通气治疗稳定期COPD的临床疗效观察[J].热带医学杂志,2014,14(10):1316-1317;1346.
[12]高秀玲,孔君.家庭无创正压通气治疗慢性阻塞性肺病稳定期的疗效分析[J].中国社区医师(医学专业),2011,13(30):27.
[13]孙春娟,王文明.长期家庭无创正压通气对严重COPD稳定期的疗效观察[J].内蒙古医学杂志,2010,42(10):1262-1263.
[14]刘姣艳.家庭无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭急性加重疗效的分析[J].医学美学美容,2014(12):166-167.
[15]李航,王臣玉,初美华,等.家庭无创正压机械通气治疗稳定期重度慢性阻塞性肺疾病患者的临床研究[J].中华结核和呼吸杂志,2011,34(7):540-542.
[16]邹从胜.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的应用与观察[J].医学信息,2015,28(12):217-218.
[17]热西汗·依不拉音,夏迪亚·夏木西丁.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察[J].当代医学,2012(33):105-106.
[18]杨红萍,洪哲云.慢性阻塞性肺疾病患者应用家庭无创通气的护理[J].中华医院感染学杂志,2011,21(2):267-269.
[19]苏爱峰.院外无创呼吸机治疗慢性阻塞性肺疾病稳定期的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(4):121-123.
[20]陈鹃.家庭无创通气治疗慢性阻塞性肺疾病的护理[J].中国社区医师(医学专业),2013,15(1):280-281.
[21]林国勇.长期无创正压通气在稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的应用价值[J].现代诊断与治疗,2015,26(20):4752-4754.
[22]王斌.慢性阻塞性肺疾病患者家庭应用无创机械通气疗效观察[J].临床合理用药杂志,2014,7(7):19-20.
[23]孟令儒,戚应静,陈卫民,等.慢性阻塞性肺疾病合并慢性呼吸衰竭患者长期家庭无创通气64例临床观察[J].中国医疗前沿,2009,4(7):85-86.
[24]叶创新.无创双水平正压通气治疗重度-极重度慢性阻塞性肺疾病稳定期的效果观察[J].现代诊断与治疗,2014,25(24):5718-5719.
[25]郑晓璐,李明生,魏厚华,等.家庭双水平无创正压机械通气对稳定期极重度COPD患者的疗效观察[J].中国医药导报,2012,9(1):132-134.
[26]Halbert RJ,Natoli JL,Gano A,et al.Global burden of COPD:systematic review and meta-analysis[J].Eur Respir J,2006,28(3):523-532.
[27]董卫平.长期家庭氧疗对慢性阻塞性肺疾病合并慢性肺源性心脏病患者肺动脉高压和高黏血症的影响[J].中国呼吸与危重监护杂志,2006,5(3):185-188.
[28]陈英华,张立军.BiPAP无创呼吸机联合呼吸兴奋剂治疗COPD合并Ⅱ型呼衰的疗效观察[J].临床肺科杂志,2015,20(2):297-299.
[29]余静.无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效[J].中华临床医师杂志,2016,10(4):216.
[30]韩利红.BiPAP无创呼吸机对重度COPD合并慢性呼吸衰竭患者的疗效分析[D].郑州:郑州大学,2016:1-52.
[31]陈宏,尚愚,于方飞,等.家庭应用无创机械通气对COPD患者肺功能及医疗费用的影响[J].现代生物医学进展,2013,12(13):2325-2327.
[32]Seetho IW,Asher R,Parker RJ,et al.Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnoea[J].Sleep Breath,2015,19(4):1155-1165.
[33]万小兵,陈宇洁,陆海英.无创呼吸机辅助治疗老年慢性阻塞性肺疾病合并呼吸衰竭的临床效果研究[J].实用心脑肺血管病杂志,2015,23(9):96-98.
[34]Skomro RP,Gjevre J,Reid J,et al.Outcomes of homebased diagnosis and treatment of obstructive sleep apnea[J].Chest,2010,138(2):257-263.
[35]Damjanovic D,Fluck A,Bremer H,et al.Compliance in sleep apnoea therapy:influence of home care support and pressure mode[J].Eur Respir J,2009,33(4):804-811.
[36]Richards D,Bartlett DJ,Wong K,et al.Increased adherence to CPAP with a group cognitive behavioral treatment intervention:a randomized trial[J].Sleep,2007,30(5):635-640.