高流量鼻导管与双水平气道正压通气在儿童重症哮喘中的临床有效性——系统评价与荟萃分析。
完整摘要 · 中文译文
入住儿科重症监护病房（PICU）最常见的原因是哮喘。经鼻高流量湿化氧疗（HFNC）和双水平气道正压通气（BiPAP）是治疗重症哮喘的辅助疗法。本系统评价旨在评估HFNC和BiPAP治疗儿科重症哮喘的临床有效性。遵循PRISMA 2020指南，在PubMed、Scopus、Google Scholar、Embase、Lilacs和ProQuest中进行了全面检索，检索时间截至2025年9月。采用JBI偏倚风险工具进行偏倚评估。使用STATA 16版（2019软件）对符合条件的研究数据进行荟萃分析，置信区间为95%。分析纳入了五项评估HFNC和BiPAP临床有效性的研究。大多数研究的偏倚风险为中低度。在PICU住院时间（p = 0.48）、住院时间（p = 0.13）、升级治疗率、呼吸支持持续时间、镇静水平或所需辅助药物用量方面，HFNC组与BiPAP组之间未观察到统计学显著差异。关于插管率和死亡率的数据不足。此外，各结果之间存在相当大的异质性，且证据的整体确定性较低。因此，当前证据仍无定论，需要设计良好且效能充足的随机对照试验才能得出明确结论。
完整摘要 · 英文原文
The most common reason for admission to the pediatric intensive care unit (PICU) is asthma. The high-flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP) are adjunctive therapies in the treatment of critical asthma. The purpose of this systematic review is to evaluate the clinical effectiveness of HFNC and BiPAP in the treatment of Pediatric critical asthma. Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, Google Scholar, Embase, Lilacs, and ProQuest till September 2025. Bias assessment was done using the JBI risk of bias tool. In STATA version 16, 2019 software, a meta-analysis was conducted using eligible study data, with a 95% confidence interval. The analysis included five studies evaluating the clinical effectiveness of HFNC and BiPAP. A moderate to low risk of bias was demonstrated by the majority of the studies. A statistically significant difference was not observed between the HFNC and BIPAP groups in terms of the length of stay in the PICU (p = 0.48), the length of stay in the hospital (p = 0.13), the rate of escalation, the duration of respiratory support, the level of sedation, or the amount of adjunctive medication needed. There were insufficient data on intubation rates and mortality. Furthermore, there was considerable heterogeneity in the results, and the certainty of the evidence was low overall. Therefore, current evidence remains inconclusive, and well-designed, adequately powered randomized controlled trials are needed for definitive conclusions.