Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China; Research Unit of Respiratory Disease, Central South University, Changsha, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China.
Ann Palliat Med. 2021 May;10(5):5137-5145. doi: 10.21037/apm-20-2017. Epub 2021 Apr 30.
As newly emerging evidence was given, we conducted a meta-analysis of randomized controlled trials (RCTs) with the following objectives: (I) to evaluate the effect of long-term noninvasive ventilation (NIV) on posthospital chronic obstructive pulmonary disease (COPD) patients with respiratory failure in mortality, blood gas, exacerbation frequency; (II) to distinguish different follow-up length of long-term NIV and its effect on these outcomes.
We tried to conduct and report this meta-analysis in accordance with the Cochrane Handbook (version 5.1.0) by searching the PubMed, Embase, Cochrane Library, and Chinese Biomedical Literature for RCTs in humans through April 2020. Studies comparing treatment effects of domiciliary NIV with control therapy in posthospital COPD patients were conducted, and at least one of the following parameters were reviewed: mortality, gas exchange, and exacerbation frequency.
Five studies with 419 subjects were identified. The exacerbation frequency significantly decreased in patients who received domiciliary NIV [weighted mean difference (WMD) -1.74, 95% CI: -2.90 to -0.57, P=0.004]. No significant difference was found in mortality, partial pressure of arterial oxygen (PaO2), PaCO2, and pH. Subgroup analysis of PaCO2 showed that domiciliary NIV of 3 months was most likely to decrease PaCO2, but not significant (WMD -2.95, 95% CI: -6.11 to 0.21, P=0.07).
The results indicate that domiciliary NIV decreases the exacerbation frequency of posthospital COPD patients, but may not improve mortality or gas exchange. Further studies are needed to evaluate the benefit of domiciliary NIV on COPD patients.
随着新出现的证据，我们进行了一项随机对照试验（RCT）的荟萃分析，目的如下：（I）评估长期无创通气（NIV）对呼吸衰竭后慢性阻塞性肺疾病（COPD）患者的死亡率、血气、加重频率的影响；（II）区分长期 NIV 的不同随访时间及其对这些结果的影响。
我们试图按照 Cochrane 手册（第 5.1.0 版）进行并报告这项荟萃分析，通过检索 PubMed、Embase、Cochrane 图书馆和中国生物医学文献，搜索 2020 年 4 月前的人类 RCT。比较家庭 NIV 与对照治疗对呼吸衰竭后 COPD 患者的治疗效果的研究，并且至少回顾了以下参数之一：死亡率、气体交换和加重频率。
确定了五项涉及 419 例患者的研究。接受家庭 NIV 的患者加重频率显著降低[加权均数差（WMD）-1.74，95%CI：-2.90 至-0.57，P=0.004]。死亡率、动脉血氧分压（PaO2）、PaCO2 和 pH 无显著差异。PaCO2 的亚组分析表明，家庭 NIV 3 个月最有可能降低 PaCO2，但无统计学意义（WMD -2.95，95%CI：-6.11 至 0.21，P=0.07）。
结果表明，家庭 NIV 降低了呼吸衰竭后 COPD 患者的加重频率，但可能不能改善死亡率或气体交换。需要进一步研究来评估家庭 NIV 对 COPD 患者的益处。
