摘要
目的探讨体外膜肺氧合(ECMO)支持应用于感染甲型H1N1流感病毒危重症患者肺保护策略的Meta分析。方法在中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)等文献检索网站中输入ECMO、甲型H1N1流感病毒危重症及肺保护等主要关键词,借助于排除法(计算机排除和手工排除)剔除不符合筛选条件的文献,通过全文阅读的方式共选出10篇符合随机对照试验(RCT)的文献进行Meta分析,将其纳入Revman5.3统计软件统计分析,采用合并比值比(OR)评价ECMO在感染甲型H1N1流感病毒危重症治疗中的临床疗效和对肺保护的影响并分析其文献偏倚。结果①存活组ECMO治疗时间的平均值较死亡组更短,差异有统计学意义(P<0.05)。②异质性检验和固定效应模型分析发现,10项研究均有异质性(P=0.01,I^2=46.0%),ECMO支持可保护肺功能(MD=0.83,P<0.0001)。③ECMO对感染甲型H1N1流感病毒危重症患者的肺功能相对危险度(OR=0.96)较高,不能改善其病死率,但随研究时间逐渐后移,ECMO对该病患者肺功能预后改善有帮助。④ECMO支持过程中存活组患者的肺功能改善程度较死亡组更优(P<0.05),但不同干预时间比较差异无统计学意义(P>0.05)。⑤10项研究中感染甲型H1N1流感病毒危重症患者实施ECMO支持治疗后散点多集中于漏斗图右侧,文献存在偏倚。结论ECMO支持在一定程度上可改善感染甲型H1N1流感病毒危重症患者预后,病因可逆的感染甲型H1N1流感病毒危重症患者应结合其病情及早予以ECMO治疗,提升临床治疗效益。
Objective To explore the meta analysis of the protective strategy of cardiopulmonary bypass membrane oxygenation(ECMO)in critically ill patients with influenza A(H1N1)virus infection.Methods Key words such as ECMO,influenza A(H1N1)virus critical illness and lung protection are input into CNKI,CBM,VIP,baidu academic and other literature retrieval websites.Based on the elimination method(computer exclusion and manual exclusion),the unqualified literature is eliminated and the full text is read A total of 10 articles in accordance with RCT were selected for meta analysis and included in Revman 5.3 statistical software for statistical analysis.The combined ratio(or)was used to evaluate the clinical efficacy and lung protection of ECMO in the treatment of severe influenza A(H1N1)virus infection.Finally,funnel chart was used to analyze whether the included articles were biased.Results①The mean time of ECMO treatment in the survival group was shorter than that in the death group(P<0.05).②Heterogeneity test and fixed effect model analysis showed that there was heterogeneity between 10 studies(P=0.01,I^2=46.0%),and ECMO support could protect lung function(MD=0.83,P<0.0001).③ECMO has a high relative risk of pulmonary function(OR=0.96)in critically ill patients with influenza A(H1N1)virus infection,which can not improve the mortality rate.However,with the study time gradually moving backward,ECMO is helpful to improve the prognosis of pulmonary function in critically ill patients with influenza A(H1N1)virus infection.④In the course of ECMO support,the improvement of pulmonary function in the survival group was better than that in the death group(P<0.05),but there was no significant difference in different intervention time(P>0.05).⑤After ECMO treatment,the scattered points of 10 articles ill patients infected with influenza A(H1N1)virus were mostly concentrated on the right side of funnel diagram,and the literature was biased.Conclusion ECMO support can improve the prognosis of patients with severe influenza A(H1N1)virus infection to a certain extent.Patients with influenza A(H1N1)virus infection should be treated with ECMO as soon as possible in combination with their condition,so as to improve the clinical treatment efficiency.
作者
韩燚
付玉兰
杨燕
陈焕玲
HAN Yi;FU Yu-lan;YANG Yan(Department of Emergency,Shanghai Armed Police Corps Hospital,Shanghai 201103,China)
出处
《临床和实验医学杂志》
2020年第19期2085-2089,共5页
Journal of Clinical and Experimental Medicine
关键词
体外膜肺氧合支持
甲型H1N1流感病毒
危重症
肺保护
META分析
Extracorporeal membrane oxygenation support
Influenza A H1N1 virus
Critical illness
Lung protection
Meta analysis
