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中华重症医学电子杂志

中华重症医学电子杂志 ›› 2024, Vol. 10 ›› Issue (03) : 227 -235. doi: 10.3877/cma.j.issn.2096-1537.2024.03.004

重症医学研究

经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析
李海亮1, 俞云1, 张星星1, 陈管洁1, 刘玲1, 谢剑锋1, 常炜1,†()   
  1. 1. 210009　南京，江苏省重症医学重点实验室　东南大学附属中大医院重症医学科
  • 收稿日期:2023-10-30 出版日期:2024-08-28
  • 通信作者: 常炜
  • 基金资助:
    东南大学附属中大医院护理科研立项课题(KJZC-HL-202008)

Meta-analysis of efficacy of high-flow nasal cannula oxygen therapy during endotracheal intubation in critically ill patients

Hailiang Li1, Yun Yu1, Xingxing Zhang1, Guanjie Chen1, Ling Liu1, Jianfeng Xie1, Wei Chang1,†()   

  1. 1. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
  • Received:2023-10-30 Published:2024-08-28
  • Corresponding author: Wei Chang
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李海亮, 俞云, 张星星, 陈管洁, 刘玲, 谢剑锋, 常炜. 经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析[J]. 中华重症医学电子杂志, 2024, 10(03): 227-235.

Hailiang Li, Yun Yu, Xingxing Zhang, Guanjie Chen, Ling Liu, Jianfeng Xie, Wei Chang. Meta-analysis of efficacy of high-flow nasal cannula oxygen therapy during endotracheal intubation in critically ill patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(03): 227-235.

目的

探讨经鼻高流量氧疗（HFNC）在危重症患者气管插管过程中呼吸暂停期间持续应用的效果。

方法

检索中国知网、维普、万方、PubMed、Cochrane Library及Embase中关于危重症患者气管插管过程中应用HFNC效果的随机对照试验（RCT）研究，检索时限为建库至2023年7月30日。由2名研究者独立进行文献筛选、资料提取和质量评价，采用RevMan5.4软件进行统计分析。

结果

纳入英文文献6篇，共计855例患者。荟萃分析结果显示，相较于常规组，HFNC组在气管插管过程中可以维持更高的血氧饱和度（SpO2）（%，MD：84，95%CI：0~1.68，P = 0.05），ICU住院时间明显缩短（d，MD：1.8，95%CI：0.84~2.76，P = 0.0002）；2组SpO2<80%发生率（OR=0.88，95% CI：0.62~1.25，P = 0.49）、气管插管相关并发症发生率（OR = 0.72，95%CI：0.52~1.01，P = 0.06）、28 d病死率（OR = 0.76，95%CI：0.55~1.05，P = 0.10）比较，差异均无统计学意义。

结论

气管插管过程中持续使用HFNC能维持更高的SpO2，并且与ICU住院时间缩短密切相关，但临床还需要更多的研究来明确HFNC维持呼吸暂停氧合对气管插管危重症患者的益处。

关键词: 经鼻高流量氧疗, 气管插管, 呼吸暂停, 荟萃分析
Objective

To investigate the efficacy of high-flow nasal cannula oxygen (HFNC) during endotracheal intubation in critically ill patients.

Methods

Database including CNKI, VIP, Wanfang, PubMed, Cochrane Library, and Embase for randomized controlled studies on the eff icacy of continuous HFNC therapy during endotracheal intubation in critically ill patients was searched from inception to July 30, 2023. Literature screening, data extraction, and quality evaluation were independently performed by two investigators to enable statistical analysis using RevMan 5.4 software.

Results

The results of our meta-analysis showed that compared with conventional therapy, HFNC could maintain a higher pulse oxygen saturation (SpO2) during endotracheal intubation (%, MD=84, 95% CI: 0~1.68, P = 0.05), and futher a significantly shorter ICU stay (d, MD=1.8, 95% CI: 0.84~2.76, P = 0.0002); there was no significant difference in the incidence of SpO2 < 80% (OR=0.88, 95% Cl: 0.62-1.25, P = 0.49), the incidence of endotracheal intubation-related complications (OR=0.72, 95% Cl: 0.52-1.01, P = 0.06), and 28-day mortality (OR=0.76, 95% Cl: 0.55-1.05, P = 0.10) between the two groups.

Conclusion

Continuous use of HFNC during endotracheal intubation can maintain higher SpO2 and is closely related to shortened ICU stay, but more clinical studies are needed to clarify the benefits of HFNC to maintain apnoeic oxygenation in critically ill patients during endotracheal intubation.

Key words: High-flow nasal cannula oxygen, Endotracheal intubation, Apnea, Meta-analysis
图1 文献筛选流程
表1 纳入文献的基本特征
研究作者及文献年份 中心来源及ICU数 年龄（岁，±s） 主要诊断 氧合指数（I/C，mmHg） 例数（I/C） 干预措施 结局指标
I C
Frat等[8]，2019 法国，28家 64±13 ARDS 148±70/142±65 171/142 PreOx：HFNC（60 L/min FiO2：1.0）3~5 min
ApOx：HFNC（60 L/min FiO2：1.0）		 PreOx：NIV（PEEP：5 cmH2O FiO2：1.0）3~5 min
ApOx：无		 abcde
Guitton等[11]，2019 法国，7家 60±18 意识状态改变、急性呼吸衰竭 318（242，396）/375（276，446） 95/89 PreOx：HFNC（60 L/min FiO2：1.0）4 min
ApOx：HFNC（60 L/min FiO2：1.0）		 PreOx：SMO（15 L/min）4 min
ApOx：无		 abcde
Simon等[12]，2016 德国，1家 58±11 急性低氧性呼吸衰竭 200±57/205±59 20/20 PreOx：HFNC（50 L/min FiO2：1.0）3 min
ApOx：HFNC（50 L/min FiO2：1.0）		 PreOx：BVM（15 L/min）3 min
ApOx：无		 ab
Jaber等[13]，2016 法国，1家 61±8 急性低氧性呼吸衰竭 107（74，264）/140（83，201） 25/24 PreOx：HFNC（60 L/min FiO2：1.0）+NIV（PEEP：5 cmH2O FiO2：1.0）4 min
ApOx：HFNC（60 L/min FiO2：1.0）		 PreOx：NIV（PEEP：5 cmH2O FiO2：1.0）4 min
ApOx：无		 abcde
Vourc’h等[14]，2015 法国，6家 62±14 急性低氧性呼吸衰竭 120.2±55.7/115.7±63.0 62/57 PreOx：HFNC（60 L/min FiO2：1.0）3 min
ApOx：HFNC（60 L/min FiO2：1.0）		 PreOx：HFFM（15 L/min）3 min
ApOx：无		 abcde
Semler等[15]，2015 美国，1家 60±12 急性呼吸衰竭、意识状态改变 未提及 77/73 PreOx：NRM、BIPAP、BVM、NC
ApOx：HFNC（15 L/min FiO2：1.0）		 PreOx：NRM、BIPAP、BVM、NC
ApOx：无		 abc
表2 纳入文献的质量评价结果
研究作者及文献年份 随机 分配隐藏 盲法 撤出与退出 改良版Jadad量表总分
Frat等[8]，2019 2 2 1 1 6
Guitton等[11]，2019 2 2 1 1 6
Simon等[12]，2016 2 2 0 1 5
Jaber等[13]，2016 2 2 1 1 6
Vourc’h等[14]，2015 2 2 1 1 6
Semler等[15]，2015 2 2 1 0 5
图2 HFNC对危重症患者气管插管过程中最低SpO2的影响注：HFNC为经鼻高流量氧疗；SpO2为血氧饱和度
图3 HFNC对危重症患者气管插管过程中SpO2<80%发生率的影响注：HFNC为经鼻高流量氧疗；SpO2为血氧饱和度
图4 HFNC对危重症患者气管插管后ICU住院时间的影响注：HFNC为经鼻高流量氧疗
图5 HFNC对危重症患者气管插管过程中相关并发症发生率的影响注：HFNC为经鼻高流量氧疗
图6 HFNC对危重症患者气管插管后28 d病死率的影响注：HFNC为经鼻高流量氧疗
图7 文章发表偏移漏斗图。图a：气管插管过程中最低SpO2；图b：SpO2<80%发生率；图c：ICU住院时间；图d：气管插管相关并发症发生率；图e：28 d病死率注：SpO2为血氧饱和度
图8 HFNC对危重症患者气管插管过程中最低SpO2影响的TSA注：HFNC为经鼻高流量氧疗；SpO2为血氧饱和度；TSA为试验序贯分析
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