无创正压通气对急性呼吸衰竭患者拔管后再插管率和预后影响的荟萃分析

：Objective To evaluatethe effects of noninvasive positive pressure ventilation (NPPV)used after extubation onmortality and rate of reintubation in patients with acute respiratory failure (ARF).MethodPubmed, Embase, Web of Science databases were searched to collect data from randomizedcontrolled trials (RCT) of the relevant subject from January 1995 to May 2010. Metaanalysis of data about NPPV on mortality and rate of reintubation in patients afterextubation carried out by using the methods recommended by the Cochrane Collaboration.Results Six RCTs included sample size of 381 NPPV and 379routine medical care. In total,the mortalities of patients in NPPV group and routine medical care group were 18.6%(62/334) vs. 21.6% (72/333), respectively, and the rates of reintubation of the two groupswere 30.2% (115/381) vs. 33.5% (127/379), respectively. Compared with routine medicalcare, NPPV did not significantly reduce the mortality ( OR: 0.83, 95% CI =0.57 ～ 1.21 ,P =0.34) and rate ofreintuation( OR: 0.83, 95% CI = 0.59 ～ 1.16, ( P = 0.27). When the analysis was focused to thefour studies of them in which patients received NPPV as soon as extubation, the resultswere quite different. From these four studies, the mortalities of patients in NPPV groupand routine medical care group were 12. 2% (22/181) vs.23.9% (44/184),(P=0.004), and therate of reintubation of the two groups were 14.0% (32/228) vs.20.4% (47/230), (P =0.07).Compared with routine medical care, early application of NPPV to patients after extubationreduced the mortality. Conclusions This study suggests the favorable effects of earlyapplication of NPPV to patients after extubation on the mortality of acute respiratoryfailure. Key words: Noninvasive positive pressure ventilation;  Acute respiratory failure;  Mortality; Meta