亚低温治疗对心搏骤停患者预后影响的Meta分析

Efficacy of mild hypothermia on the prognosis of patients with cardiac arrest:a Meta-analysis

目的评价目前临床最常用的亚低温治疗方法即体表降温并适当予以冬眠合剂对心搏骤停(CA)后经心肺复苏恢复自主循环的患者预后的影响。方法通过Medline,Web of Science,EMBASE,Cochrane Library,中文生物医学文献数据库(CMCC),中国科技期刊全文数据库(CNKI)及万方数据库,维普科技期刊全文数据库(VIP)检索符合条件的文献,检索时间限定建库至2017年10月26日。试验组为通过体表降温达到亚低温来治疗CA后心肺复苏成功的患者,对照组为常规治疗组;应用Jadad质量评价量表对纳入文献进行质量评估,使用Review Manager 5.3软件进行Meta分析及异质性检验。结果共纳入6项随机对照试验,1 588例患者,试验组对CA后心肺复苏患者出院后病死率没有明显改善作用[RR=0.95,95%CI:0.86~1.06,P=0.11],对神经功能的恢复差异有统计学意义[RR=1.34,95%CI:1.01~1.78,P=0.01]。结论 CA自主循环恢复后经体表降温并适当予以冬眠合剂的方法行亚低温治疗对出院后病死率无明显效果,但可改善患者出院后神经功能预后。

Objective To evaluate the efficacy of surface cooling and appropriate hibernation mixture,the most commonly used mild hypothermia therapy at present,on the prognosis of patients successfully resuscitated from cardiac arrest by cardiopulmonary resuscitation(CPR).Methods Medline Pubmed,Web of Science,EMBASE,Chinese Medical Current Content(CMCC),China National Knowledge Infrastructure(CNKI)and Wanfang Medical Network Platform were searched,the search time was limited to 26 October 2017.Studies include the following criteria(1)randomized controlled trial(RCT);(2)patients with successful CPR after cardiac arrest in the experimental group was treated by with mild hypothermia,the control group was treated with conventional;(3)results of studies include the survival till hospital discharge and recovery of neurological function.The quality of the included literatures was assessed by using the Jadad Quality Assessment Scale,and the Review Manager 5.3 software was used for Meta-analysis and heterogeneity testing.Results A total of 6 RCTs,1 588 patients,were enrolled in this study.No significant different was found in the mortality of CPR patients after cardioversion in the experimental group after hospital discharge(RR=0.95,95%CI:0.86-1.06,P=0.11).Compared to the control group,the recovery of neural function in the experimental group was statistically significant[RR=1.34,95%CI:1.01-1.78,P=0.01].Conclusion Mild hypothermia treatment through the method of surface cooling combined with proper hibernation mixture for patients who successfully resuscitated from cardiac arrest by CPR has no obvious effect on post-discharge mortality,but it can improve the recovery of neurological function after hospital discharge.