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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (01) : 39 -44. doi: 10.3877/cma.j.issn.1674-6880.2024.01.006

荟萃分析

经鼻高流量氧疗对急性低氧性呼吸衰竭患者住院病死率的累积Meta分析
岳伟岗1, 蒋由飞1, 尹瑞元1, 吴雨晨1, 曾丽2,†(), 田金徽3   
  1. 1. 730000　兰州，兰州大学第一医院重症医学科
    2. 730000　兰州，兰州大学第一医院呼吸与危重症医学科
    3. 730000　兰州，兰州大学循证医学中心；730000　兰州，甘肃省循证医学与临床转化重点实验室
  • 收稿日期:2023-10-28 出版日期:2024-02-29
  • 通信作者: 曾丽
  • 基金资助:
    兰州市科技计划项目(2020-ZD-78); 兰州大学第一医院院内基金项目(ldyyyn2019-68)

Hospital mortality in patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula oxygen therapy: a cumulative meta-analysis

Weigang Yue1, Youfei Jiang1, Ruiyuan Yin1, Yuchen Wu1, Li Zeng2,†(), Jinhui Tian3   

  1. 1. Department of Intensive Medicine, the First Hospital of Lanzhou University, Lanzhou 730000, China
    2. Department of Respiratory and Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou 730000, China
    3. Evidence Based Medicine Center of Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Clinical Transformation of Gansu Province, Lanzhou 730000, China
  • Received:2023-10-28 Published:2024-02-29
  • Corresponding author: Li Zeng
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引用本文：

岳伟岗, 蒋由飞, 尹瑞元, 吴雨晨, 曾丽, 田金徽. 经鼻高流量氧疗对急性低氧性呼吸衰竭患者住院病死率的累积Meta分析[J]. 中华危重症医学杂志(电子版), 2024, 17(01): 39-44.

Weigang Yue, Youfei Jiang, Ruiyuan Yin, Yuchen Wu, Li Zeng, Jinhui Tian. Hospital mortality in patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula oxygen therapy: a cumulative meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(01): 39-44.

目的

系统评价经鼻高流量（HFNC）氧疗对急性低氧性呼吸衰竭患者住院病死率的影响。

方法

计算机检索PubMed、Web of Sience、the Cochrane Library、中国知网、维普及万方数据库中自建库至2022年6月30日公开发表的关于HFNC对急性低氧性呼吸衰竭患者影响的随机对照试验（RCT）。试验组采用HFNC给氧，对照组采用普通面罩（FM）或无创正压通气（NIPPV）给氧。由2名研究人员独立筛选文献、评价文献质量、提取数据资料。采用StataSE 12.0软件进行累积Meta分析，同时采用试验序贯分析（TSA）方法评估研究结果的可靠性及真实性。

结果

共纳入11篇文献，包括患者2 989例，其中试验组1 464例，对照组1 525例（FM 830例、NIPPV 695例）。累积Meta分析结果显示，HFNC能够降低急性低氧性呼吸衰竭患者住院病死率[相对危险度（RR）= 0.66，95%置信区间（CI）（0.51，0.86），Z = 3.050，P = 0.002]。TSA结果显示，虽然住院病死率的样本量（n = 2 989）未达到期望信息量（RIS，n = 3 997），但累积的Z值穿过传统界值和TSA界值，提示就目前纳入研究的样本量已获得较肯定的结果。

结论

HFNC氧疗可有效降低急性低氧性呼吸衰竭患者住院病死率。

关键词: 经鼻高流量氧疗, 无创正压通气, 急性低氧性呼吸衰竭, 累积Meta分析, 试验序贯分析
Objective

To evaluate the effect of high-flow nasal cannula (HFNC) oxygen therapy on the hospital mortality in patients with acute hypoxemic respiratory failure through a cumulative meta-analysis.

Methods

Randomized controlled trials (RCTs) on the effect of HFNC on patients with acute hypoxemic respiratory failure published up to June 30, 2022 were searched from PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wanfang databases. Patients in the experimental group received HFNC oxygen therapy, while patients in the control group were treated with face mask (FM) or noninvasive positive pressure ventilation (NIPPV) oxygen therapy. Relevant data were screened, evaluated and extracted by two researchers independently. Then the StataSE 12.0 software was utilized for a cumulative meta-analysis, and the trial sequential analysis (TSA) was used to evaluate the research results.

Results

A total of 2 989 patients were enrolled in 11 articles, including 1 464 in the experimental group and 1 525 in the control group (830 in FM and 695 in NIPPV). The cumulative meta-analysis showed that HFNC could reduce the hospital mortality of patients with acute hypoxemic respiratory failure [relative risk (RR) = 0.66, 95% confidence interval (CI) (0.51, 0.86), Z = 3.050, P = 0.002]. The TSA showed that the sample size of hospital mortality (n = 2 989) had not reached the required information size (RIS, n = 3 997), but the cumulative Z-value had crossed the traditional cut-off value and TSA cut-off value, indicating that the study obtained relatively positive results.

Conclusion

The HFNC oxygen therapy can effectively reduce the hospital mortality of patients with acute hypoxemic respiratory failure.

Key words: High-flow nasal cannula oxygen therapy, Noninvasive positive pressure ventilation, Acute hypoxemic respiratory failure, Cumulative meta-analysis, Trial sequential analysis
表1 纳入研究的基本特征
纳入研究 例数（例） 男/女（例） 年龄[岁， ± s或M（P25，P75）] 干预措施 结局指标
试验组 对照组 试验组 对照组 试验组 对照组 试验组 对照组
Parke等[5] 169 171 129/40 129/42 65 ± 17.2 66 ± 16.9 HFNC FM 住院病死率
Maggiore等[6] 53 52 33/20 35/18 65 ± 18 64 ± 17 HFNC FM 住院病死率
Futier等[7] 108 112 61/47 64/48 62 ± 12 61 ± 13 HFNC FM 住院病死率
Jones等[8] 165 138 73/92 71/67 74.6 ± 15.6 72.2 ± 16.8 HFNC FM 住院病死率
Hernandez等[9] 264 263 164/100 154/109 51.0 ± 13.1 51.8 ± 12.2 HFNC FM 住院病死率
Frat等[10] 106 204 75/31 137/67 61 ± 16 61 ± 17 HFNC FM/NIPPV 住院病死率
Stephan等[11] 414 416 273/141 278/138 63.8 ± 12.7 63.9 ± 13.1 HFNC NIPPV 住院病死率
Coudroy等[12] 33 24 17/16 18/6 62 ± 11.0 62 ± 11.0 HFNC NIPPV 住院病死率
Yoo等[13] 34 39 18/16 25/14 62.1 ± 16.8 62.9 ± 16.1 HFNC NIPPV 住院病死率
Chang等[14] 58 46 37/21 28/18 74.5（63.8，82.3） 72.5（61.8，79） HFNC NIPPV 住院病死率
Shang等[15] 60 60 32/28 39/21 67.4 ± 4.8 66.8 ± 6.9 HFNC NIPPV 住院病死率
表2 纳入文献的偏倚风险评价
纳入研究 随机方法 分配隐藏 盲法 结果数据完整性 选择性报告研究结果 其他偏倚来源 质量等级
Parke等[5] 低风险 低风险 不清楚 低风险 低风险 不清楚 B
Maggiore等[6] 低风险 低风险 低风险 低风险 低风险 不清楚 B
Futier等[7] 低风险 低风险 低风险 低风险 低风险 不清楚 A
Jones等[8] 低风险 低风险 低风险 低风险 低风险 不清楚 B
Hernandez等[9] 低风险 低风险 低风险 低风险 低风险 不清楚 A
Frat等[10] 低风险 低风险 低风险 低风险 低风险 不清楚 A
Stephan等[11] 低风险 低风险 低风险 低风险 低风险 不清楚 A
Coudroy等[12] 中风险 不清楚 不清楚 低风险 低风险 不清楚 C
Yoo等[13] 中风险 不清楚 不清楚 低风险 低风险 不清楚 C
Chang等[14] 中风险 不清楚 不清楚 低风险 低风险 不清楚 C
Shang等[15] 低风险 不清楚 不清楚 低风险 低风险 不清楚 B
图1 HFNC氧疗对急性低氧性呼吸衰竭患者住院病死率影响的累积Meta分析注：HFNC.经鼻高流量；RR.相对危险度；CI.置信区间
图2 HFNC氧疗对急性低氧性呼吸衰竭患者住院病死率影响的TSA分析注：HFNC.经鼻高流量；TSA.试验序贯分析；RIS.期望信息量
图3 HFNC氧疗对急性低氧性呼吸衰竭患者住院病死率影响的Begg’s分析注：HFNC.经鼻高流量；RR.相对危险度；圆圈的大小代表文献的权重（样本量大小）
图4 HFNC氧疗对急性低氧性呼吸衰竭患者住院病死率影响的敏感性分析注：HFNC.经鼻高流量；CI.置信区间；RR.相对危险度
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