当前位置:科学网首页 > 小柯机器人 >详情
家庭无创正压通气可改善慢性阻塞性肺病的临床结局
作者:小柯机器人 发布时间:2020/2/11 10:06:27

近日,美国明尼苏达州梅奥诊所Zhen Wang及其课题组对家庭无创正压通气与慢性阻塞性肺病临床结局的关系进行了系统回顾和荟萃分析。相关论文发表在2020年2月4日出版的《美国医学会杂志》上。

家庭无创正压通气(NIPPV)与慢性阻塞性肺病(COPD)伴高碳酸血症预后的关系尚不明确。

为了探讨经双水平气道正压通气(BPAP)装置和无创呼吸机(HMV)装置进行家庭NIPPV治疗COPD伴高碳酸血症的临床疗效和不良反应,研究组在MEDLINE、EMBASE、SCOPUS等大型数据库中对1995年1月1日至2019年11月6日出版的英文文献进行筛查,检索使用家庭NIPPV超过1个月的COPD伴高碳酸血症成年人的随机临床试验和比较观察研究。

最终共纳入21项随机对照试验和12项观察研究,共评估51085名患者,平均年龄为65.7岁,43%为女性,其中434名患者死亡,27名患者插管。

使用BPAP与不使用任何设备相比,死亡率显著降低(分别为22.31%和28.57%,比值比为0.66),全因住院率显著降低(分别为39.74%和75.00%,比值比为0.22),插管率显著降低(分别为5.34%和14.71%,比值比为0.34)。全因住院的总人数或生活质量均无显著差异。

使用无创HMV与不使用任何设备相比,全因住院率显著降低,比值比为0.50,但死亡率相差不大。使用NIPPV的患者的不良事件总数与未使用NIPPV相比差异无统计学意义。

总之,在COPD伴高碳酸血症患者的荟萃分析中,使用家庭BPAP与不使用设备相比,死亡率、全因入院率和插管率均显著降低,但生活质量差异不大。与不使用设备相比,无创性HMV显著降低了住院风险,但死亡率相差不大。

附:英文原文

Title: Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Author: Michael E. Wilson, Claudia C. Dobler, Allison S. Morrow, Bradley Beuschel, Mouaz Alsawas, Raed Benkhadra, Mohamed Seisa, Aniket Mittal, Manuel Sanchez, Lubna Daraz, Steven Holets, M. Hassan Murad, Zhen Wang

Issue&Volume: 2020/02/04

Abstract:

Importance  The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain.

Objective  To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia.

Data Sources  Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019.

Study Selection  Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included.

Data Extraction and Synthesis  Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies.

Main Outcomes and Measures  Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up.

Results  A total of 21 RCTs and 12 observational studies evaluating 51085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], 5.53% [95% CI, 10.29% to 0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P=.003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, 35.26% [95% CI, 49.39% to 21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P.001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, 8.02% [95% CI, 14.77% to 1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P=.02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P=.47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, 0.06 to 0.39]; P=.15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P.001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, 11.99% [95% CI, 24.77% to 0.79%]; OR,0.56 [95% CI, 0.29-1.08]; P=.49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P=.84; 6 studies; 414 patients).

Conclusions and Relevance  In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.

DOI: 10.1001/jama.2019.22343

Source: https://jamanetwork.com/journals/jama/article-abstract/2760390

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex