中药灌肠联合无创通气治疗AECOPD合并呼吸衰竭的有效性和安全性Meta分析

Meta-Analysis of the Efficacy and Safety of Herbal Enema Combined with Noninvasive Ventilation in the Treatment of AECOPD Combined with Respiratory Failure

摘要: 目的：对中药灌肠联合无创通气治疗AECOPD合并呼吸衰竭的临床研究进行质量评价和数据分析，旨在评价中药灌肠联合无创通气治疗AECOPD合并呼吸衰竭的有效性和安全性，为临床诊断和治疗提供循证医学证据。方法：运用计算机系统对中国知网(CNKI)、维普(VIP)、万方(WanFang Data)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane Library、Embase以上8个数据库进行检索，检索主题为中药灌肠联合无创通气治疗AECOPD合并呼吸衰竭为的随机对照试验，检索时限设置为建库至2023年12月底。对文献进行审阅和信息提取，并使用Cochrane偏倚风险评估工具对明确纳入的研究进行质量和偏倚风险评估，使用RevMan5.3软件对明确纳入的研究进行Meta分析。结果：共纳入RCT文献11篇，共涉及患者781例，其中治疗组391例，对照组390例。Meta分析结果：中药灌肠联合西医基础及无创正压通气治疗AECOPD合并呼吸衰竭在各方面均具有优势。提高总有效率[OR = 5.13, 95%CI (2.55, 10.32), P < 0.00001]；改善呼吸频率[MD = −1.90, 95%CI (−3.25, 0.54), P = 0.006]；提高动脉血氧分压[MD = 4.63, 95%CI (1.12, 8.14), P = 0.010]；降低动脉血二氧化碳分压[MD = −4.22, 95%CI (−5.56, −2.88), P < 0.00001]；提高动脉血氧饱和度[MD = 5.19, 95%CI (2.44, 7.94), P = 0.00002]；缩短无创通气时间[MD = −2.87, 95%CI (−3.65, −2.10), P < 0.00001]；缩短机械通气时间[MD = −2.31, 95%CI (−2.94, −1.68), P < 0.00001]。结论：在治疗AECOPD合并呼吸衰竭时，中药灌肠联合无创正压通气及西医常规治疗有显著提高总有效率、提高动脉血氧分压及血氧饱和度、降低动脉血二氧化碳分压、改善呼吸频率、缩短无创通气时间及机械通气时间等优势，且安全性良好。但所纳入文献数量少、质量不高，多种因素影响可信度，需要更多高质量的RCT支持。

Abstract: Objective: Quality evaluation and data analysis of clinical studies of herbal enema combined with noninvasive ventilation for the treatment of AECOPD combined respiratory failure were conducted with the aim of evaluating the effectiveness and safety of herbal enema combined with noninvasive ventilation for the treatment of AECOPD combined respiratory failure, and to provide evidence-based medical evidence for clinical diagnosis and treatment. Methods: A computerized system was used to search CNKI, VIP, WanFang Data, CBM, PubMed, Web of Science, Cochrane Library, Embase, and more than eight databases, and the subject of the search was the randomized controlled trials of herbal enema combined with noninvasive ventilation for the treatment of AECOPD combined with respiratory failure, and the timeframe of the search was set as the establishment of the database to the end of December 2023. Literature was reviewed and information extracted, and quality and risk of bias were assessed for explicitly included studies using the Cochrane risk of bias assessment tool, and Meta-analysis was performed for explicitly included studies using RevMan 5.3 software. Results: A total of 11 RCTs were included in the literature, involving a total of 781 patients, including 391 in the treatment group and 390 in the control group. Meta-analysis results: Traditional Chinese medicine enema combined with Western basic and noninvasive positive pressure ventilation for the treatment of AECOPD combined respiratory failure was advantageous in all aspects. It improved the total effective rate [OR = 5.13, 95%CI (2.55, 10.32), P < 0.00001]; improved respiratory rate [MD = −1.90, 95%CI (−3.25, 0.54), P = 0.006]; increased arterial blood oxygen partial pressure [MD = 4.63, 95%CI (1.12, 8.14), P = 0.010]; decreased arterial blood carbon dioxide partial pressure [MD = −4.22, 95%CI (−5.56, −2.88), P < 0.00001]; enhanced arterial blood oxygen saturation [MD = 5.19, 95%CI (2.44, 7.94), P = 0.00002]; shortened noninvasive ventilation time [MD = −2.87, 95%CI (−3.65, −2.10), P < 0.00001]; and shortened duration of mechanical ventilation [MD = −2.31, 95%CI (−2.94, −1.68), P < 0.00001]. Conclusion: In the treatment of AECOPD combined with respiratory failure, traditional Chinese medicine enema combined with noninvasive positive pressure ventilation and conventional Western medicine have the advantages of significantly increasing the overall effective rate, increasing the arterial oxygen partial pressure and oxygen saturation, decreasing the arterial carbon dioxide partial pressure, improving the respiratory rate, and shortening the duration of noninvasive and mechanical ventilation, and the safety is good. However, the included literature is small in quantity and quality, and multiple factors affect the credibility, which needs to be supported by more high-quality RCTs.