高频振荡通气与常频通气治疗小儿急性呼吸窘迫综合征疗效的Meta分析

A Meta analysis of the efficacy of high-frequency oscillatory ventilation versus conventional mechanical ventilation for treating pediatric acute respiratory distress syndrome

摘要:

目的 系统评价高频震荡通气（HFOV）与常频机械通气（CMV）治疗小儿急性呼吸窘迫综合征（ARDS）的疗效。方法 计算机检索The Cochrane Library、PubMed、Medline、中国知网（CNKI）、万方（Wanfang Data）等数据库，收集关于HFOV与CMV比较治疗儿童ARDS的随机对照试验，检索时限从建库至2016年7月。由两位评价员按照纳入与排除标准独立筛选文献、提取资料并对文献质量进行评价，然后采用RevMan 5.3软件将纳入的研究进行Meta分析。结果 最终纳入6项试验，共246例患儿。Meta分析结果显示：HFOV和CMV两种通气方式治疗在院内病死率或30 d病死率、气压伤发生率、平均通气时间和氧合指数方面差异均无统计学意义（P > 0.05）；但相较CMV，HFOV提高了PaO₂/FiO₂比值（治疗后24 h、48 h、72 h分别提高了17%、24%、31%），改善了患儿氧合。结论 与CMV相比，HFOV并没有降低ARDS患儿的病死率，但可显著改善氧合状态。最终结论尚需更多大样本、多中心、随机的临床对照研究进一步验证。

Abstract:

Objective To systematically assess the clinical efficacy of high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) for treating pediatric acute respiratory distress syndrome (ARDS). Methods Data from randomized controlled trials comparing HFOV and CMV in the treatment of pediatric ARDS published before July 2016 were collected from the Cochrane Library, PubMed, Medline, CNKI, and Wanfang Data. Literature screening, data extraction, and quality assessment were performed by two independent reviewers according to the inclusion and exclusion criteria. The selected studies were then subjected to a Meta analysis using the RevMan 5.3 software. Results A total of 6 studies involving 246 patients were included. The results of the Meta analysis showed that there were no significant differences between the HFOV and CMV groups in the in-hospital or 30-day mortality rate, incidence of barotrauma, mean ventilation time, and oxygenation index (P > 0.05). However, compared with CMV, HFOV increased the PaO₂/FiO₂ ratio by 17%, 24%, and 31% at 24, 48, and 72 hours after treatment respectively, and improved oxygenation in patients. Conclusions Although the mortality rate is not reduced by HFOV in children with ARDS, this treatment can result in significant improvement in oxygenation compared with CMV. Further large-sample, multicenter, randomized clinical trials will be required to draw a definitive conclusion.