吸气阻力阀联合心肺复苏术对心脏骤停患者疗效的Meta分析

Effect of impedance threshold device with cardiopulmonary resuscitation in heart arrest patients: a meta-analysis

目的系统评价应用吸气阻力阀(ITD)联合心肺复苏术(CPR)对心脏骤停患者的疗效。方法计算机检索Pub Med、ISI WOK平台数据库、Science Online、Nature、中文生物医学文献库(CMCC)、万方数据资源、CNKI中国知网、维普电子资源数据库中关于应用ITD和未使用ITD进行CPR的临床对照研究,检索时间为2000年至2015年6月。由2名研究者按照纳入及排除标准独立进行文献筛选、资料提取和质量评估后,采用Revman 5.3软件对数据进行Meta分析。结果共纳入8项研究,共包括138 992例心脏骤停患者,其中应用ITD组(ITD组)患者7 056例,未应用ITD(对照组)患者6 936例。Meta分析结果显示,自主循环恢复率两组间比较差异无统计学意义[OR=1.03,95%CI(0.96,1.11),Z=0.93,P=0.35],复苏后改良Rankin评分≤3的比例ITD组明显优于对照组[OR=1.74,95%CI(1.11,2.73),Z=2.40,P=0.02],复苏后存活出院率ITD组优于对照组[OR=1.40,95%CI(1.04,1.91),Z=2.18,P=0.03]。亚组分析结果显示,应用ITD联合主动胸外按压-减压心肺复苏术(ACD-CPR)(ITD+ACD-CPR)组的自主循环恢复率[OR=1.13,95%CI(1.01,1.26),Z=2.11,P=0.03]、复苏后改良Rankin评分≤3的比例[OR=1.53,95%CI(1.22,1.93),Z=3.67,P<0.001]及复苏后存活出院率[OR=1.25,95%CI(1.04,1.49),Z=2.38,P=0.02]均明显优于对照组。结论应用吸气阻力阀联合ACD-CPR可以提高心脏骤停患者心肺复苏成功率。

Objective To assess the effect of impedance threshold device（ITD） with cardiopulmonary resuscitation（CPR） in heart arrest patients. Methods Systematic searches were conducted in Pub Med, ISI WOK, Science Online, Nature, CMCC, Wangfang data, CNKI and VIP to collect clinical comparative study on whether to apply ITD from 2000 to June 2015. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted the data and evaluated the quality of the included studies. The meta-analysis was performed using Revman 5.3. Results Eight studies involving 138 992 heart arrest patients were included.There were no signifcant differences on the rate of return of spontaneous circulation（ROSC）[OR = 1.03, 95% CI（0.96, 1.11）, Z = 0.93, P = 0.35] between the two groups, but the rates of modified ranking scale（MRS） ≤ 3 [OR = 1.74, 95% CI（1.11, 2.73）, Z = 2.40, P = 0.02] and the hospital discharge [OR = 1.40, 95% CI（1.04, 1.91）, Z = 2.18, P = 0.03] in the ITD group were much better than those in the control group. The subgroup analysis also implicated that compared with the control group, the rates of ROSC [OR = 1.13, 95% CI（1.01,1.26）, Z = 2.11,P = 0.03], MRS ≤ 3 [OR = 1.53, 95%CI（1.22,1.93）, Z = 3.67, P〈0.001] and hospital discharge[OR = 1.25, 95%CI（1.04,1.49）, Z = 2.38, P = 0.02] in the ITD combined with active compressiondecompression cardiopulmonary resuscitation（ACD-CPR） group increased obviously. Conclusion ITD combined with ACD-CPR can improve the success rate of CPR in heart arrest patients.