不同无创正压通气模式对我国COPD合OSAHS患者疗效的Meta分析

刘茜; 曹钰洁; 王登本; 李阳; 高颖; 刘美芳; 李建英

文章摘要

刘茜，曹钰洁，王登本，李阳，高颖，刘美芳，李建英.不同无创正压通气模式对我国COPD合OSAHS患者疗效的Meta分析[J].实用中西医结合临床,2022,22(6):1-6,26

不同无创正压通气模式对我国COPD合OSAHS患者疗效的Meta分析

The Efficacy of Different Non-Invasive Positive Pressure Ventilation Patterns on the Treatment of COPD Combined with OSAHS in China: A Meta Analysis

DOI：

中文关键词: 慢性阻塞性肺疾病阻塞性睡眠呼吸暂停低通气综合征双相气道正压通气持续气道正压通气

英文关键词: Chronic obstructive pulmonary disease Obstructive sleep apnea hypoventilation syndrome Bi-level positive airway pressure Continuous positive airway pressure

基金项目:陕西省西安市科技计划项目（编号：2019115713YX012SF045）；陕西省重点研发计划项目（编号：2019SF-020）；陕西省西安市科技计划项目[编号：20200001YX001（1）]

作者	单位
刘茜，曹钰洁，王登本，李阳，高颖，刘美芳，李建英	陕西省西安市中心医院；延安大学医学院2021级硕士研究生；延安大学医学院2020级硕士研究生；延安大学医学院2019级硕士研究生

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中文摘要:

目的：采用Meta分析评价双相气道正压通气（BiPAP）与持续气道正压通气（CPAP）对我国慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的成效。方法：通过计算机检索中国知网（CNKI）、万方医学数据库、维普中文科技期刊数据库（VIP）等中文数据库，检索时间从建库至2022年1月，提取相应资料后采用RevMan5.4软件、Stata15.0软件进行Meta分析。结果：最终纳入11篇中文文献，800例患者。Meta分析结果显示：BiPAP较CPAP能更好地改善动脉血pH（MD=0.08，95%CI：0.06~0.10，P＜0.000 01），增加患者的动脉氧分压（MD=5.56，95%CI：2.04~9.08，P=0.002），降低动脉二氧化碳分压（MD=-6.72，95%CI：-9.99~-3.46，P＜0.000 1），提高夜间最低氧饱和度（MD=2.46，95%CI：1.24~3.68，P＜0.000 1），改善睡眠呼吸暂停低通气指数（MD=-4.14， 95%CI：-6.35~-1.92，P=0.000 3），缩短最长呼吸暂停时间（MD=-5.59，95%CI：-7.85~-3.32，P＜0.000 01）。纳入的11篇文章中，有3篇介绍了治疗的相关不良反应及死亡病例，BiPAP组腹胀4例、口鼻咽干燥4例、气胸3例、死亡病例1例，分别低于CPAP组的腹胀8例、口鼻咽干燥9例、气胸7例、死亡病例16例，差异有统计学意义。结论：相较于CPAP，BiPAP更利于缓解人群重叠综合征导致的呼吸窘迫，可显著改善动脉血气各指标、睡眠呼吸暂停低通气指数、夜间最低氧饱和度和最长呼吸暂停时间，除此之外，BiPAP组死亡病例及不良反应均比CPAP组少，证实了CPAP治疗的安全性与有效性。

英文摘要:

Objective: To evaluate the efficacy of Bi-level positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) on the group of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea hypoventilation syndrome (OSAHS) in china using Meta-analysis. Methods: Chinese knowledge resources database (CNKI), Wanfang medical network database, Weip chinese science and technology journal database (VIP) and other chinese databases were searched by computer, from database construction to January 2022. After extracting the corresponding data, Meta-analysis was analyzed using RevMan5.4 software and Stata15.0 software. Results: 11 Chinese publications with 800 patients were finally included. The Meta-analysis showed that BiPAP improved the arterial blood pH better than CPAP (MD=0.08, 95%CI: 0.06~0.10, P＜0.000 01), increase the arterial oxygen partial pressure in the patient (MD=5.56, 95%CI: 2.04~9.08, P=0.002), reduce the arterial carbon dioxide partial pressure (MD= -6.72, 95%CI: -9.99~-3.46, P＜0.000 1), improve the SpO2Low (MD= 2.46, 95%CI: 1.24~3.68, P＜0.000 1), improve AHI (MD= -4.14, 95%CI: -6.35~-1.92, P= 0.000 3), reduce the maximum apnea time (MD= -5.59, 95%CI: -7.85~-3.32, P＜0.000 01). Among the 11 articles included, 3 introduced the adverse reactions and deaths related to treatment, 4 cases of abdominal distension, 4 cases of dry nasopharyngeal, 3 cases of pneumothorax, and 1 case of death in the BiPAP group, which were lower than 8 cases of abdominal distension, 9 cases of dry nasopharyngeal, 7 cases of pneumothorax, and 16 cases of death in the CPAP group, respectively, with statistically significant differences. Conclusion: Compared with CPAP, BiPAP was better able to relieve respiratory distress in patients with the overlapping syndrome in the Chinese population, and significantly improved the arterial blood gas index, AHI, SpO2Low and the longest apnea time. In addition, its deaths and adverse effects were lower than those in the CPAP group, confirming its safety and effectiveness..

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