体外膜肺氧合治疗脓毒症患者生存预后的Meta分析

Survival prognosis of extracorporeal membrane oxygenation on patients with sepsis:a meta-analysis

目的系统评价体外膜肺氧合(ECMO)对脓毒症患者生存率的影响。方法计算机检索知网、万方、维普、中国生物医学文献服务系统、PubMed、Web of Science、Cochrane Library、Embase等数据库2011年1月至2020年7月期间公开发表的关于ECMO治疗脓毒症患者的相关研究。由2名研究人员独立进行文献筛选、数据提取及质量评估,并采用Stata 15.0软件进行单臂研究的Meta分析。结果共纳入13篇研究,合计660例患者。Meta分析结果示,ECMO治疗[相对危险度(RR)=0.32,95%置信区间(CI)(0.22,0.42),Z=9.841,P<0.001]、静脉-动脉ECMO(VA-ECMO)治疗[RR=0.29,95%CI(0.17,0.42),Z=7.100,P<0.001]及静脉-静脉ECMO(VV-ECMO)治疗[RR=0.53,95%CI(0.40,0.66),Z=14.950,P<0.001]均可明显提高脓毒症患者的出院生存率。且对于脓毒性休克患者的出院生存率[RR=0.33,95%CI(0.19,0.46),Z=4.686,P<0.001]、肺部感染导致脓毒症患者的出院生存率[RR=0.22,95%CI(0.13,0.32),Z=7.140,P<0.001]、年龄>60岁脓毒症患者的出院生存率[RR=0.06,95%CI(0.00,0.15),Z=2.108,P=0.011]及脓毒症患者的长期生存率[RR=0.82,95%CI(0.70,0.94),Z=13.410,P<0.001],ECMO治疗后均显著提高。结论ECMO治疗能改善脓毒症患者的生存预后。

Objective To systematically evaluate the effect of extracorporeal membrane oxygenation(ECMO)on the survival rate of patients with sepsis.Methods The articles about ECMO for sepsis patients published from January 2011 to July 2020 were searched in CNKI,Wanfang,VIP,China Biomedical Literature Service System,PubMed,Web of Science,Cochrane Library,and Embase databases.Two researchers independently screened articles,extracted data,and evaluated the quality of articles.Then the meta-analysis was performed using the Stata 15.0 software.Results A total of 660 patients from 13 articles were included in this study.Meta-analysis showed that the discharge survival rates of sepsis patients treated by ECMO[risk ratio(RR)=0.32,95%confidence interval(CI)(0.22,0.42),Z=9.841,P<0.001],veno-arterial ECMO(VA-ECMO)[RR=0.29,95%CI(0.17,0.42),Z=7.100,P<0.001],and veno-venous ECMO(VV-ECMO)[RR=0.53,95%CI(0.40,0.66),Z=14.950,P<0.001]all improved obviously.The discharge survival rates in patients with septic shock[RR=0.33,95%CI(0.19,0.46),Z=4.686,P<0.001],patients with sepsis caused by pulmonary infection[RR=0.22,95%CI(0.13,0.32),Z=7.140,P<0.001],and patients with sepsis>60 years of age[RR=0.06,95%CI(0.00,0.15),Z=2.108,P=0.011],as well as the long-term survival rate of patients with sepsis[RR=0.82,95%CI(0.70,0.94),Z=13.410,P<0.001]all increased remarkably after ECMO treatment.Conclusion ECMO treatment can improve the prognosis of patients with sepsis.