双水平气道正压通气对重叠综合征并呼吸衰竭患者疗效的Meta分析

涂学平,王念,肖锦秀等.双水平气道正压通气对重叠综合征并呼吸衰竭患者疗效的Meta分析[J].国际呼吸杂志,2013,33(5):352-357.

双水平气道正压通气;重叠综合征;呼吸衰竭

涂学平 王念 肖锦秀 胡克

430060,武汉大学人民医院呼吸科

2014年

352-357

万方

目的 评价经口/鼻面罩双水平气道正压通气(bilevel positive airway pressure ventilation,BiPAP)对重叠综合征(overlap syndrome,OS)并发呼吸衰竭患者的治疗作用.方法 计算机检索PubMed、Medline、万方数据库、中国知网和维普数据库中关于BiPAP治疗OS患者并发呼吸衰竭的随机对照研究,检索时限为建库至2012年6月,同时追索有用的参考文献.并对相关数据进行分析,统计学分析采用Review Manager 5软件进行.结果 共纳入6个随机对照试验(randomized controlled trial,RCT),273例患者.Meta分析2个主要结局的结果显示:BiPAP联合临床常规治疗对OS患者并发呼吸衰竭的PaO2及PaCO2的影响与单纯临床常规治疗比较,其中6项研究中BiPAP联合临床常规治疗组与常规治疗组治疗后的PaO2差异有统计学意义[WMD=19.75,95％ CI (18.43,21.07)],5项研究中的两组治疗后的PaCO2差异有统计学意义[WMD=-12.13,95％ CI(-13.72,-i0.54)].结论 研究显示,BiPAP联合临床常规治疗可以明显改善OS患者并发呼吸衰竭的PaO2及PaCO2,临床医师可以将BiPAP联合临床常规治疗作为推荐.但鉴于纳入的研究较少,样本量小,且鉴于呼吸机治疗研究的研究性质及伦理道德问题,故难于做到双盲,研究的方法学质量不高,故仍需开展大样本、多中心、方法规范和科学的高质量RCT,以求进一步验证BiPAP加临床常规治疗对OS患者并发呼吸衰竭的疗效. Objective To evaluate the therapeutic effect of bilevel positive airway pressure ventilation (BiPAP) on overlap syndrome (OS) complicated with respiratory failure.Methods PubMed,Medline,Wanfang Data,CNKI and VIP were searched for the randomized controlled trials (RCT) of the therapeutic effect of BiPAP on overlap syndrome complicated with respiratory failure from the date of establishment of the databases to June 2012.The bibliographies of the in-cluded studies were searched too.The extracted data were analyzed by Review Manager 5.Results A total 6 trials(273 patients) were discovered.Meta-analyses showed that standard therapy plus BiPAP,compared with standard therapy alone,can improve PaO2 and PaCO2 (WMD =19.75,95％ CI 18.43 to 21.07 and WMD ＝-12.13,95％ CI-13.72 to-10.54,respectively).Conclusions The evidence shows standard therapy plus BiPAP can improve PaO2 and PaCO2 of overlap synd-rome complicated with respiratory failure.The clinicians should recommend it.Because of the limitations of the included studies,more large-sample and high-quality RCT are required.。