普通氧疗和高流量鼻导管治疗在不同临床环境中对阻塞性睡眠呼吸暂停患者的有效性：一项系统综述和Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：潘志军 编辑：宋雨婷 审校：曹莹
评估普通氧疗和高流量鼻导管（HFNC）治疗在不同临床环境中对阻塞性睡眠呼吸暂停（OSA）患者的有效性，以评估其在术后患者中的应用。
从1946年到2021年12月16日，对MEDLINE和其他数据库进行了系统搜索。标题和摘要筛选独立进行，主要研究者解决两者出现冲突的情况。Meta分析采用随机效应模型进行，并以平均差和标化均数差及95％置信区间呈现。这些使用RevMan 5.4计算。
1395名和228名OSA患者分别接受普通氧疗和HFNC治疗。
普通氧疗和HFNC治疗。
呼吸暂停-低通气指数（AHI），血氧饱和度（SpO2），SPO2 <90％的累积时间（CT90）。
本综述纳入了27项氧气治疗研究，其中10项随机对照试验（RCT），7项随机交叉试验，7项非随机交叉试验和3项前瞻性队列。汇总分析显示，与基线相比，氧疗显著降低了AHI 31％，并将SpO2提高了5％；与基线相比，持续气道正压（CPAP）显著降低了AHI 84％，并将SpO2提高了3％。CPAP比氧气治疗更有效地降低AHI 53％，但两种治疗在提高SpO2方面具有相似的有效性。本综述纳入了9项HFNC研究，其中5项前瞻性队列研究，3项随机交叉试验和1项RCT。汇总分析显示，HFNC治疗显著降低了AHI 36％，但并未显著提高SpO2。
氧疗有效降低OSA患者的AHI并提高SpO2。CPAP比氧气治疗更有效地降低AHI。HFNC治疗有效降低AHI。尽管氧疗和HFNC治疗都能有效降低AHI，但需要更多的研究来得出关于临床结果的结论。
原始文献来源：
Brandon Ruan,Mahesh Nagappa, Matin Rashid-Kolvear,et al.The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis [J]. (J Clin Anesth. 2023 Sep;88:111144).
英文原文：
The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis
Study objective: To evaluate the effectiveness of supplemental oxygen therapy and high-flow nasal cannula (HFNC) therapy in patients with obstructive sleep apnea (OSA) in different clinical settings to assess its application to surgical patients in the postoperative setting.
Design: A systematic search was conducted on MEDLINE and other databases from 1946 to December 16th, 2021. Title and abstract screening were conducted independently, and the lead investigators resolved conflicts. Metaanalyses were performed using a random-effects model and are presented as mean difference and standardized mean difference with 95% confidence intervals. These were calculated using RevMan 5.4.
Patients: 1395 and 228 OSA patients underwent oxygen therapy and HFNC therapy respectively.
Interventions: Oxygen therapy and HFNC therapy.
Measurements: Apnea-hypopnea index (AHI), oxyhemoglobin saturation (SpO2), cumulative time with SPO2 <90% (CT90).
Main results: Twenty-seven oxygen therapy studies were included in the review, with ten randomized controlled trials (RCT), seven randomized crossovers, seven non-randomized crossovers, and three prospective cohorts. Pooled analyses showed that oxygen therapy significantly reduced AHI by 31% and increased SpO2 by 5% versus baseline, and CPAP significantly reduced AHI by 84%, and increased SpO2 by 3% versus baseline. CPAP was 53% more effective in reducing AHI than oxygen therapy, but both treatments had similar effectiveness in increasing SpO2. Nine HFNC studies were included in the review, with five prospective cohorts, three randomized crossovers, and one RCT. Pooled analyses showed that HFNC therapy significantly reduced AHI by 36% but did not substantially increase SpO2.
Conclusions: Oxygen therapy effectively reduces AHI and increases SpO2 in patients with OSA. CPAP is more effective in reducing AHI than oxygen therapy. HFNC therapy is effective in reducing AHI. Although both oxygen therapy and HFNC therapy effectively reduce AHI, more research is needed to draw conclusions on clinical outcomes.
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