早產兒呼吸窘迫使用高流量鼻導管與鼻腔持續氣道正壓通氣醫療成本與醫療效果分析-系統性回顧與統合分析

Cost and Effectiveness of Applying Nasal High Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Prematurity With Respiratory distress Syndrome : Systematic Review and Meta-Analysis

陳敏惠(Min-Hui Chen)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2019年)

摘要

摘要
研究目的
近10年高流量鼻導管廣泛運用於臨床，改善早產兒呼吸窘迫症候群之呼吸支持裝置替代鼻腔持續氣道正壓通氣，裝置使用有效性及安全性備受專注，相關文獻探討臨床使用效益且結論分析不同，關於醫療成本相關文獻極為少見，國內無相關文獻探討新生早產兒使用高流量鼻導管之醫療費用，因健保財政缺口擴大，使醫療花費及成本管理逐漸被重視，藉此研究探討早產兒呼吸窘迫使用高流量鼻導管（HFNC）相對於使用鼻腔持續氣道正壓通氣（N-CPAP）在成本及療效之差異性。

研究方法
文獻搜尋使用之資料庫包含PubMed、MEDLINE Complete、Cochrane Library（2010年1月至2019年2月)及華藝圖書，針對妊娠週數小於37週並有呼吸窘迫症候群新生早產兒，利用系統性文獻回顧及統合分析，探討兩組病人在醫療資源耗用及醫療療效使用之差異。本研究使用Comprehensive Meta-Analysis (CMA)第三版統計軟體，以隨機效應模式整合分析了解兩組使用模式對於早產新生兒在成本及療效之差異性。

研究結果
利用PRISMA文獻篩選及Jadad品質評量表共有12篇文獻進行統合分析，研究結果發現：高流量鼻導管比鼻腔持續氣道正壓通氣醫療費用成本顯著較低（Standard Difference in Means =–0.19，P=0.002），72小時內重插管率顯著較高（OR=1.33，P =0.012 ），呼吸器使用天數顯著較高（Standard Difference in Means =0.21，P<0.001），鼻子損傷顯著較低（OR=0.35，P= 0.001），支氣管肺疾病並無達到統計差異（OR=1.23，P= 0.503）。

結論與建議
統合分析結果發現高流量鼻導管比鼻腔持續氣道正壓通氣具有成本效果，醫療費用及鼻子損傷呈現較低，但HFNC比N-CPAP有較高重插管率。需要更多隨機臨床試驗（RCT）證據用於新生早產兒來比較為HFNC臨床的有效性和成本效益提供依據，包括重新插管、支氣管肺疾病（BPD）、死亡和許多重要不良事件。

關鍵詞
新生早產兒、鼻腔持續氣道正壓通氣、高流量鼻導管、統合分析

關鍵字

新生早產兒 ； 鼻腔持續氣道正壓通氣 ； 高流量鼻導管 ； 統合分析

並列摘要

Abstract
BACKGROUND:
Nasal high flow therapy is an alternative to nasal continuous positive airway pressure (N-CPAP) as a means of respiratory support for premature infants. The efficacy and safety of high-flow therapy has been gradually emphasized. However, few studies addressed about cost-effectiveness analysis of Nasal High flow Therapy versus Nasal Continuous Positive Airway Pressure in premature infants. Therefore, this study explored the cost and effectiveness between nasal high flow therapy and nasal continuous positive airway pressure among premature infants.

METHODS:
Four databases (PubMed, Medline Complete, Cochrane Library, Airiti Library) were performed from January 2010 to February 2019 with no language restriction. All premature infants of respiratory distress with gestation age less than 37 weeks and those using noninvasive mechanical ventilation were our target population. After assessing for inclusion, data extraction used the PRISMA Checklist and we also applied the Jadad decision algorithm to select the best evidence review. Finally, there are twelve studies were included in the meta-analysis.

RESULTS:
Nasal High flow Therapy on medical expenses were significantly reduction with Nasal Continuous Positive Airway Pressure on medical expenses（Standard Difference in Means =-0.19, P=0.002）. Reintubation within 72 hours on nasal high flow therapy more significantly with nasal continuous positive airway pressure (OR=1.33, P=0.012). Significant differences of Mechanical ventilation days on nasal high flow therapy with nasal continuous positive airway pressure (Standard Difference in Means =0.21, P<0.001). Nasal injury was significant differences with nasal continuous positive airway pressure (OR=0.35, P=0.001). No significant differences were found for bronchopulmonary dysplsia（OR=1.23，P=0.503）.

CONCLUSIONS:
The outcome supports the Cost-effectiveness of nasal high flow therapy was significant differences with nasal continuous positive airway pressure. However, reintubation ration within 72 hours and Mechanical ventilation days on nasal high flow therapy more than nasal continuous positive airway pressure. Needed more proposal of randomized controlled trials between nasal high flow therapy and nasal continuous positive airway pressure in critical care for better evidence about reintubation, bronchopulmonary dysplsia and mortality.

Keyword
premature 、High Flow Nasal Cannula 、 Nasal Continuous Positive Airway Pressure 、 Respiratory distress syndrome、Comprehensive Meta-Analysis

並列關鍵字

premature ； High Flow Nasal Cannula ； Nasal Continuous Positive Airway Pressure ； Respiratory distress syndrome ； Comprehensive Meta-Analysis

參考文獻

參考文獻

Badiee, Z., F. Naseri, and A. Sadeghnia. 2013. 'Early versus delayed initiation of nasal continuous positive airway pressure for treatment of respiratory distress syndrome in premature newborns: A randomized clinical trial', Adv Biomed Res, 2: 4.

Bond, S., R. Leguillette, E. A. Richard, L. Couetil, J. P. Lavoie, J. G. Martin, and R. S. Pirie. 2018. 'Equine asthma: Integrative biologic relevance of a recently proposed nomenclature', J Vet Intern Med.

Chao, Ke-Yun, Yi-Ling Chen, Li-Yi Tsai, Yu-Hsuan Chien, and Shu-Chi Mu. 2017. 'The Role of Heated Humidified High-flow Nasal Cannula as Noninvasive Respiratory Support in Neonates', Pediatrics & Neonatology, 58: 295-302.

Collins, C. L., C. Barfield, R. S. C. Horne, and P. G. Davis. 2013. 'A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure', European Journal of Pediatrics, 173: 181-86.