高流量鼻导管与常规氧疗在高碳酸血症性慢性阻塞性肺疾病患者中的比较：系统评价和荟萃分析。
Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
机构信息
Department of Respiratory and Critical Care Medicine, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou City, Jiangsu Province, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Clinical Medical College, Yangzhou University, Yangzhou City, Jiangsu Province, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2023 May 16;18:895-906. doi: 10.2147/COPD.S402506. eCollection 2023.
PURPOSE
This study aimed to evaluate the clinical outcomes of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT) in patients with hypercapnic chronic obstructive pulmonary disease (COPD), including arterial partial pressure of carbon dioxide (PaCO), arterial partial pressure of oxygen (PaO), respiratory rate (RR), treatment failure, exacerbation rates, adverse events and comfort evaluation.
PATIENTS AND METHODS
PubMed, EMBASE and the Cochrane Library were retrieved from inception to September 30, 2022. Eligible trials were randomized controlled trials and crossover studies comparing HFNC and COT in hypercapnic COPD patients. Continuous variables were reported as mean and standard derivation and calculated by weighted mean differences (MD), while dichotomous variables were shown as frequency and proportion and calculated by odds ratio (OR), with the 95% confidence intervals (Cl). Statistical analysis was performed using RevMan 5.4 software.
RESULTS
Eight studies were included, five with acute hypercapnia and three with chronic hypercapnia. In acute hypercapnic COPD, short-term HFNC reduced PaCO (MD -1.55, 95% CI: -2.85 to -0.25, I² = 0%, p <0.05) and treatment failure (OR 0.54, 95% CI: 0.33 to 0.88, I² = 0%, p<0.05), but there were no significant differences in PaO (MD -0.36, 95% CI: -2.23 to 1.52, I² = 45%, p=0.71) and RR (MD -1.07, 95% CI: -2.44 to 0.29, I² = 72%, p=0.12). In chronic hypercapnic COPD, HFNC may reduce COPD exacerbation rates, but there was no advantage in improving PaCO (MD -1.21, 95% CI: -3.81 to 1.39, I² = 0%, p=0.36) and PaO (MD 2.81, 95% CI: -1.39 to 7.02, I² = 0%, p=0.19).
CONCLUSION
Compared with COT, short-term HFNC reduced PaCO and the need for escalating respiratory support in acute hypercapnic COPD, whereas long-term HFNC reduced COPD exacerbations rates in chronic hypercapnia. HFNC has great potential for treating hypercapnic COPD.
目的
本研究旨在评估高流量鼻导管（HFNC）与常规氧疗（COT）在伴有高碳酸血症的慢性阻塞性肺疾病（COPD）患者中的临床疗效，包括动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、呼吸频率（RR）、治疗失败率、加重率、不良事件和舒适度评估。
患者和方法
从建库到 2022 年 9 月 30 日，检索了 PubMed、EMBASE 和 Cochrane 图书馆。合格的试验为比较高碳酸血症 COPD 患者中 HFNC 和 COT 的随机对照试验和交叉研究。连续变量以均数和标准差表示，并通过加权均数差（MD）计算，二分类变量以频率和比例表示，并通过比值比（OR）计算，95%置信区间（Cl）。采用 RevMan 5.4 软件进行统计学分析。
结果
共纳入 8 项研究，其中 5 项为急性高碳酸血症，3 项为慢性高碳酸血症。在急性高碳酸血症 COPD 患者中，短期 HFNC 可降低 PaCO2（MD-1.55，95%Cl：-2.85 至-0.25，I²=0%，p<0.05）和治疗失败率（OR 0.54，95%Cl：0.33 至 0.88，I²=0%，p<0.05），但 PaO2（MD-0.36，95%Cl：-2.23 至 1.52，I²=45%，p=0.71）和 RR（MD-1.07，95%Cl：-2.44 至 0.29，I²=72%，p=0.12）差异无统计学意义。在慢性高碳酸血症 COPD 患者中，HFNC 可能降低 COPD 加重率，但对改善 PaCO2（MD-1.21，95%Cl：-3.81 至 1.39，I²=0%，p=0.36）和 PaO2（MD 2.81，95%Cl：-1.39 至 7.02，I²=0%，p=0.19）无优势。
结论
与 COT 相比，短期 HFNC 可降低急性高碳酸血症 COPD 患者的 PaCO2 和需要升级呼吸支持的比例，而长期 HFNC 可降低慢性高碳酸血症患者的 COPD 加重率。HFNC 在治疗高碳酸血症 COPD 方面具有很大的潜力。
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