系统评价加温湿化高流量鼻导管通气(HHHFNC)和经鼻持续气道正压通气(NCPAP)措施预防早产儿拔管失败的有效性和安全性。

计算机检索PubMed、Embase、Cochrane Library等英文数据库，以及万方数据知识服务平台、维普中文科技期刊数据库及中国知网(CNKI)等中文数据库中，关于比较HHHFNC与NCPAP预防早产儿拔管失败疗效的随机对照试验(RCT)研究文献，对HHHFNC组与NCPAP组早产儿分别采用HHHFNC、NCPAP模式治疗。文献检索时间设定为2000年1月1日至2018年7月31日。由2位研究者按照本研究设定的文献纳入和排除标准独立筛选文献，评价纳入文献的质量并提取资料，采用Stata 12.0软件对HHHFNC与NCPAP预防早产儿拔管失败的有效性和安全性进行Meta分析。HHHFNC与NCPAP预防早产儿拔管失败的有效性和安全性的主要结局评价指标包括：有效性指标(治疗失败率、再插管率)与安全性指标(鼻损伤、气漏发生率)；次要结局评价指标包括：院内死亡率，支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)、动脉导管未闭(PDA)、脑室内出血(IVH)、早产儿视网膜病(ROP)等并发症发生率，以及达到全肠道喂养时间。

通过文献筛选，并追踪检索已获取全文的相关参考文献，共计8篇RCT研究文献符合本研究纳入、排除标准，纳入的早产儿为1 037例，其中HHHFNC组为518例，NCPAP组为519例。①针对HHHFNC与NCPAP预防早产儿拔管失败的主要结局评价指标的Meta分析结果显示，有效性指标方面，2组早产儿治疗失败率和再插管率比较，差异均无统计学意义(OR＝1.18、0.93，95%CI：0.87～1.59、0.67～1.30，P＝0.286、0.687)；而安全性指标方面，HHHFNC组鼻损伤与气漏发生率，则均低于NCPAP组，差异均有统计学意义(OR＝0.17、0.24，95%CI：0.11～0.26、0.09～0.63，P<0.001、＝0.003)。②针对HHHFNC与NCPAP预防早产儿拔管失败的次要结局评价指标的Meta分析结果显示，2组早产儿院内死亡率(OR＝0.93，95%CI：0.40～2.13，P＝0.857)，BPD发生率(OR＝0.82，95%CI：0.66～1.11，P＝0.202)，IVH发生率(OR＝0.76，95%CI：0.46～1.27，P＝0.299)，ROP发生率(OR＝1.09，95%CI：0.69～1.73，P＝0.713)，PDA发生率(OR＝0.89，95%CI：0.62～1.28，P＝0.524)及达到全肠道喂养时间(SMD＝0.47，95%CI：－0.35～1.29，P＝0.264)比较，差异均无统计学意义(P>0.05)，而HHHFNC组早产儿NEC发生率显著低于NCPAP组，并且差异有统计学意义(OR＝0.56，95%CI：0.33～0.95，P＝0.032)。

HHHFNC与NCPAP相比，在预防早产儿拔管失败方面，有效性相似，而前者导致的鼻损伤、气漏和NEC发生率更低，安全性更高。但是，推荐HHHFNC模式作为预防早产儿拔管失败的首选无创通气模式仍然需谨慎。

To evaluate the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in preventing extubation failure in preterm infants.

The English databases including PubMed, Embase, Cochrane Library, and Chinese databases including Wanfang Data Knowledge Service Platform, VIP database, and China National Knowledge Infrastructure (CNKI) were searched to collect randomized controlled trial (RCT) researches which compared the clinical effects of HHHFNC and NCPAP in preventing extubation failure in preterm infants. Preterm infants in HHHFNC group and NCPAP group were treated with HHHFNC and NCPAP modes, respectively. Retrieval time ranged from January 1, 2000 to July 31, 2018. Two reviewers independently screened literatures, evaluated the quality of the literatures, and extracted data according to the inclusion and exclusion criteria of this research. Then, Meta-analysis was performed by using Stata 12.0 software to evaluate the efficacy and safety of HHHFNC and NCPAP in preventing extubation failure in preterm infants. The main outcome measurements included efficacy indexes (rates of treatment failure and reintubation) and safety indexes (incidence rates of nasal trauma and frequent hemorrhoid). The secondary outcome measurements included in-hospital mortality rate and incidence rates of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP), and the duration of reaching full enteral feedings.

A total of 8 eligible RCT research literatures involving 1 037 preterm infants were included in the Meta analysis. Among them, there were 518 cases in HHHFNC group and 519 cases in NCPAP group. Meta-analysis showed the following results. ①In terms of efficacy, there were no significant differences between two groups in the treatment failure rate (OR=1.18, 95%CI: 0.87-1.59, P=0.286) and reintubation rate (OR=0.93, 95%CI: 0.67-1.30, P=0.687). While in terms of safety, HHHFNC had a significant advantage over NCPAP in reducing the incidence rates of nasal trauma (OR=0.17, 95%CI: 0.11-0.26, P<0.001), and frequent hemorrhoid (OR=0.24, 95%CI: 0.09-0.63, P=0.003). ②In terms of secondary outcome measurements, there were no significant differences between two groups in the in-hospital mortality rate (OR=0.93, 95%CI: 0.40-2.13, P=0.857), and incidence rates of BPD (OR=0.82, 95%CI: 0.60-1.11, P=0.202), IVH (OR=0.76, 95%CI: 0.46-1.27, P=0.299), ROP (OR=1.09, 95%CI: 0.69-1.73, P=0.713), PDA (OR=0.89, 95%CI: 0.62-1.28, P=0.524), and duration of reaching full enteral feedings (SMD=0.47, 95%CI: -0.35-1.29, P=0.264). HHHFNC had a significant advantage over NCPAP in reducing the incidence rates of NEC (OR=0.56, 95%CI: 0.33-0.95, P=0.032).

HHHFNC appears to be similar to NCPAP in efficacy of preventing extubation failure in preterm infants. It is associated with significantly lower odds of nasal trauma, frequent hemorrhoid and NEC. However, it is recommended to be cautious as a preferred non-invasive ventilation mode to prevent extubation failure in preterm infants.