目的 评价经鼻高流量氧疗(HFNC)用于早产儿的安全性和有效性.方法 计算机检索中国知网、中国生物医学文献数据库、维普数据库、万方数据库、Medline、Embase、Web of Sience和the Cochrane Library,收集早产儿应用 HFNC(HFNC组)和经鼻持续气道正压通气(NCPAP组)的RCT,检索时间为建库至2017 年 3月31 日.主要结局指标:住院病死率和治疗失败需有创机械通气(气管插管)率;次要结局指标:支气管肺发育不良(BPD)、气漏、肺部感染和鼻部损伤的发生率,肺表面活性物质的应用率.结果 8篇文献1 604 例患儿进入本文Meta分析,HFNC 组799例,NCPAP 组 805 例.8篇均报告了计算机随机序列产生,7篇采用分配隐藏, 8篇文献均无失访、数据完整性好、研究结果无选择性报告,其他偏倚不清楚.两组病死率和气管插管率差异均无统计学意义.病死率行亚组分析,差异仍无统计学意义.气管插管率行亚组分析显示,体重均数≥1 500 g(OR=1.58,95%CI:1.11~2.26,P=0.01)和胎龄≥28周(OR=1.58,95%CI:1.13~2.22,P=0.008),NCPAP组气管插管率低于HFNC组.BPD、气漏、肺部感染发生率和肺表面活性物质应用率,两组差异无统计学意义.HFNC组鼻部损伤发生率低于NCPAP组(OR=-0.14,95%CI:-0.19~-0.09,P<0.0001).结论 HFNC应用于早产儿的疗效和安全性有待进一步证实,其鼻部损伤发生率低于NCPAP.%ObjectiveTo evaluate the efficacy and safety of high-flow nasal Cannulae (HFNC) oxygen therapy in premature infants.ethodsRCT studies were identified by a systematic search in Medline, the Cochrane Library, Web of Science, Embase, Chinese Knowledge Network, VIP, CBM and Wanfang database, from its establishment to March 31, 2017.The primary outcome was hospital mortality and the incidence of mechanical ventilation (tracheal intubation).The secondary outcome included BPD, air leakage, pulmonary infection, nasal trauma,and application of pulmonary surfactant.ResultsEight articles were included in the meta-analysis, and 1 604 children were included, including 799 cases in HFNC group, 805 cases in NCPAP group.8 articles were reported in the random sequence of the computer, 7 mentioned the use of the allocation of hidden, 8 papers were lost, data integrity was good, the results of the reports were not selective, other bias was not clear.There was no significant difference in mortality and intubation rate between the two groups.The tracheal intubation rate of NCPAP was lower than HFNC group in children with mean weight ≥1 500 g(OR=1.58,95%CI:1.11~2.26,P=0.01)and gestational age more than 28 weeks(OR=1.58,95%CI:1.13~2.22,P=0.008).There was no significant difference in the incidences of BPD, air leakage and pulmonary infection and the rate of pulmonary surfactant application between the two groups.The incidence of nasal trauma HFNC group was lower than that of NCPAP (OR=-0.14,95%CI:-0.19~-0.09,P<0.0001).ConclusionThe efficacy and safety of HFNC in premature infants should be further confirmed, but it has obvious advantages in reducing the incidence of nasal injury
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