摘要
目的评价体外膜氧合(ECMO)单用与联用俯卧位(PP)对重度急性呼吸窘迫综合征(ARDS)患者的治疗效果。方法计算机检索CNKI、PubMed等数据库在2021年5月之前公开发布的文献。由2名研究者独立进行文献筛选、数据提取和质量评价,采用RevMan 5.3软件进行统计分析。结果纳入8项研究,共873例患者,其中ECMO联用PP组351例,单用ECMO组522例。meta分析结果显示:与单用ECMO相比,ECMO联用PP可以降低病死率[相对危险度(RR)=0.76,95%可信区间(CI):0.64~0.89,P<0.05],增加ECMO成功撤机率[优势比(OR)=1.58,95%CI:1.04~2.41,P<0.05],ECMO支持时间更长[均值差(MD)=6.98,95%CI:1.22~12.73,P<0.05],改善氧合指数(MD=36.05,95%CI:6.05~66.05,P<0.05)及呼吸系统顺应性(MD=2.75,95%CI:0.94~4.57,P<0.05)的效果更佳。结论与单用ECMO相比,ECMO联用PP治疗重度ARDS患者的疗效可能更好,但因纳入研究多为回顾性研究,故尚需大型随机对照试验进一步验证。
Objective To evaluate the efficacy of extracorporeal membrane oxygenation(ECMO)alone or combined with prone position(PP)in patients with severe acute respiratory distress syndrome(ARDS).Methods Relevant literature published in CNKI,PubMed and other databases from inception up to May 2021 were systematically searched.Two reviewers strictly screened stud⁃ies,extracted data,and assesed the methodological quality.RevMan 5.3 software was used to perform the meta-analysis.Results A total of 873 patients in 8 studies were included,including 351 patients in ECMO combined with PP group and 522 patients in ECMO a⁃lone group.The meta-analysis showed that compared with ECMO alone,ECMO combined with PP could reduced the mortality(relative risk(RR)=0.76,95%confidence interval(95%CI):0.64-0.89,P<0.05),increased the success rate of weaning from ECMO(odds ratio(OR)=1.58,95%CI:1.04-2.41,P<0.05)and the duration of ECMO(mean difference(MD)=6.98,95%CI:1.22-12.73,P<0.05),improved PaO_(2)/FiO_(2)(MD=36.05,95%CI:6.05-66.05,P<0.05)and respiratory compliance(MD=2.75,95%CI:0.94-4.57,P<0.05).Conclusion Compared with ECMO alone,ECMO combined with PP may be more effective in the treatment of patients with severe ARDS.However,since most of the included studies are retrospective studies,large randomized controlled trials are needed for further validation.
作者
通耀威
居来提·肉扎洪
郭驹
李颖
王正凯
王于强
周旺涛
叶斯力·哈力木别克
宋云林
Tong Yaowei;Julaiti Rouzhahong;Guo Ju;Li Ying;Wang Zhengkai;Wang Yuqiang;Zhou Wangtao;Yesili Halimubieke;Song Yunlin(Department of Intensive Care Unit,The First Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China)
出处
《中国体外循环杂志》
2022年第3期143-149,178,共8页
Chinese Journal of Extracorporeal Circulation
基金
新疆医科大学教育改革项目(YG2019096)。
