保守氧疗在ICU患者中应用效果的Meta分析

Effect of conservative oxygen therapy in ICU patients:a Meta-analysis

目的比较保守氧疗与常规氧疗在ICU患者中的应用效果。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中有关保守氧疗与常规氧疗在ICU患者中应用效果的随机对照试验,检索时限均为建库至2022年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9项研究,5767例患者。Meta分析结果显示,与常规氧疗相比,保守氧疗能够降低ICU患者的短期病死率[OR=0.79,95%CI(0.65,0.96),P=0.020],降低休克[OR=0.33,95%CI(0.16,0.69),P=0.003]、肝功能不全[OR=0.26,95%CI(0.10,0.72),P=0.009]和ICU获得性衰弱的发生率[OR=0.50,95%CI(0.26,0.93),P=0.030],但在90 d病死率、新发感染发生率、机械通气时间、ICU入住时间、总住院时间等方面的比较,差异均无统计学意义(P>0.05)。结论现有证据表明,保守氧疗可降低ICU患者的短期病死率,降低休克、肝功能不全和ICU获得性衰弱的发生率,但在90 d病死率、新发感染发生率和住院时间等方面是否有优势有待进一步探讨。

Objective To compare the effect of conservative oxygen therapy and conventional oxygen therapy in ICU patients.Methods Databases,including PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang,VIP,and CBM,were searched to collect randomized controlled trials about the effect of conservative oxygen therapy on mortality of ICU patients from inception to March 31,2022.After 2 researchers independently screened the literature,extracted the data and evaluated the bias risks of the included study,RevMan 5.3 software was used for Meta-analysis.Results A total of 9 studies were included,with 5767 patients.Compared with conventional oxygen therapy,the results of meta-analysis showed that conservative oxygen therapy could reduce the short-term mortality of ICU patients[OR=0.79,95%CI(0.65,0.96),P=0.020]and shock[OR=0.33,95%CI(0.16,0.69),P=0.003],liver insufficiency[OR=0.26,95%CI(0.10,0.72),P=0.009]and ICU acquired weakness[OR=0.50,95%CI(0.26,0.93),P=0.030].However,there were no significant differences in 90 d mortality,incidence of new infection,duration of mechanical ventilation,length of ICU stay and length of hospital stay(P>0.05).Conclusion Existing evidence suggests that conservative oxygen therapy can reduce short-term mortality in ICU patients and the incidence of shock,liver insufficiency,and ICU acquired weakness.However,whether it has advantages in 90 d mortality,new infections,and length of hospital stay remains to be further explored.