经腹心肺复苏有效性及安全性的meta分析

Efficacy and safety of trans-abdominal cardiopulmonary resucitation:a Meta analysis

目的评价经腹心肺复苏法与标准胸外按压心肺复苏治疗心脏骤停患者有效性和安全性的系统评价,为临床运用腹部心肺复苏提供循证医学依据。方法检索万方数据库、中国知网数据库、Sinomed、PubMed、Embase、Medline和Cochrane图书馆数据库,全面检索经腹心肺复苏治疗心脏骤停患者的临床随机对照试验研究,提取数据并使用Stata软件进行meta分析,观察指标主要为经抢救后患者的病死率,患者复苏后的呼气末二氧化碳分压(ETPCO2)、平均动脉压(MAP)及神经功能缺损评分。结果共纳入10个临床随机对照试验,累计受试者1 117例。与标准胸外按压心肺复苏相比,经腹部心肺复苏法抢救心脏骤停患者可显著降低患者病死率(RR=0.77,95%CI:0.70~0.84)。其中腹部提压心肺复苏法的RR值为0.69(95%CI:0.61~0.79),插入腹部按压心肺复苏法的RR值为0.84(95%CI:0.75~0.95)。腹部提压心肺复苏法还可增加患者肺潮气量(SMD=14.29,95%CI=10.61~17.97),增加呼气末二氧化碳分压ETPCO2(SMD=5.53,95%CI:3.99~7.06),降低平均动脉压(SMD=-0.56,95%CI:-0.89^-0.24),并且减少了神经功能损害(SMD=-0.57,95%CI:-1.05^-0.09)。结论腹部提压心肺复苏法抢救心脏骤停患者的效果佳,可提高临床抢救成功率,腹部提压心肺复苏法可改善患者通气,减少神经功能损害。

Objective To evaluate the efficacy and safety of cardiopulmonary resuscitation (CPR) in rescuing patients with cardiac arrest, and to provide evidence-based medicine for clinical application of abdominal cardiopulmonary resuscitation.Methods The Wanfang database, the Chinese knowledge network database, Sinomed, PubMed, Embase and Medline and Cochrane library were retrieved and the clinical randomized controlled trial for patients with cardiac arrest by CPR was collected;the data were extracted and then the Stata software was used to carry out the meta analysis.Results The patients with cardiac arrest by abdominal cardiopulmonary resuscitation could significantly reduce the mortality of patients (RR=0.77, 95%CI=0.70-0.84, I2=75.9%, P<0.001), of which the RR value of abdominal pressure cardiopulmonary resuscitation was 0.69 (95%CI=0.61-0.79), and the RR value inserted into the abdominal compression cardiopulmonary resuscitation was 0.84 (95% CI = 0.75 - 0.95), and the abdomen was raised. CPR could also increase the volume of pulmonary moisture (SMD=14.29, 95%CI=10.61-17.97), PETCO2 (SMD=5.53, 95%CI=3.99-7.06), the end expiratory carbon dioxide (SMD=5.53, 95%CI=3.99-7.06), and reduce the mean arterial pressure (SMD=-0.56, 95%CI=-0.89-0.24) and the damage of nerve function (SMD=-0.57, 95%CI=-1.05-0.09).Conclusion Rescue of cardiac arrest patients by central pulmonary resuscitation method can improve the clinical effect, and increase the success rate of rescuing patients. Moreover, the abdominal CPR method can significantly improve the ventilation of patients, promote aerobic metabolism, and reduce neurological impairment with no serious adverse reactions.