体外膜肺氧合辅助下心肺复苏对成年心脏骤停患者生存影响的meta分析

The influence of extracorporeal cardiopulmonary resuscitation on survival in adults with cardiac arrest;a meta analysis

目的评价体外膜肺氧合辅助下心肺复苏(ECPR)对成年心脏骤停患者的生存影响。方法计算机检索CNKI、PubMed等数据库在2015年3月之前公开发表的相关文献,并对获得文献进行严格的筛选和质量评价,提取相关数据,使用STATA13.0软件进行统计分析。结果纳入五个研究,共计1 305人,其中ECPR组295人,传统心肺复苏(CCPR)组1 010人。meta分析结果显示:与CCPR相比,ECPR可以提高成年心脏骤停患者的出院生存率[相对危险度2.74,95%可信区间(2.03,3.70),P<0.001]和神经功能状态[相对危险度2.65,95%可信区间(1.86,3.77),P<0.001]。在纳入的5项研究中,4项建立了倾向评分匹配的队列,其中ECPR组与CCPR组各182人。meta分析结果同样表明:在提高成年心脏骤停患者的出院生存率[相对危险度2.53,95%可信区间(1.52,4.20),P<0.001]和神经功能状态方面[相对危险度3.27,95%可信区间(1.74,6.15),P<0.001],ECPR具有较为显著的优势。结论 ECPR在提高成年心脏骤停患者的出院生存率和神经功能状态方面,效果优于CCPR。

Objective To evaluate the influence of extracorporeal cardiopulmonary resuscitation（ECPR） on sundval in adults with cardiac arrest.Methods We searched CNKI,PubMed and other databases to collect relevant studies from inception to March2015.Two reviewers strictlyscreened studies,extracted data,and assesed the methodological quality.Then,meta-analysis was performed by using STATA13.0 software.Results Five relevant studies involving 1305 patientswere included in our review,295 cases belonging to ECPR group and 1010 cases belonging to conventional cardiopulmonary resuscitation（CCPR） group.The meta-analysis showed that the sundval[RR = 2.74,95%CI（2.03,3.70）,P〈0.001]and neurologic status[RR = 2.65,95%CI（1.86,3.77）,P〈0.001]of ECPR group were better than those of CCPR groupat discharge.Fourof the 5 studies used propensity score matching to build balanced cohorts with 182 patients in both groups.The results also showed superiority of ECPR over CCPR,in sundval[RR = 2.53,95%CI（1.52,4.20）,P〈0.001]and neurologic status at discharge[RR = 3.27,95%CI（1.74,6.15）,P〈0.001].Conclusions Current evidence suggests that the sundval and neurologic status after ECPR are superior to that after CCPRat discharge.