ECMO治疗急性呼吸窘迫综合征预后危险因素的Meta分析

Meta-analysis of Prognostic Risk Factors of ECMO in the Treatment of Acute Respiratory Distress Syndrome

目的系统性评价体外膜肺氧合(ECMO)治疗急性呼吸窘迫综合征预后的危险因素。方法计算机检索PubMed、EMbase、Web of Science、Cochrane和中国知网等数据库,筛选有关ECMO治疗ARDS预后的相关性研究,检索时限为建库至2022年3月,由2名研究者独立筛选文献、提取数据并评价纳入文献,根据RCT的偏移风险评估工具(NOS量表)对纳入的文献进行质量评价,采用Cochrane国际协作组织提供的RevMan5.4统计软件进行Meta分析。结果共纳入31篇文章,包括5585例患者。Meta分析结果显示免疫功能不全(OR=2.63,95%CI:1.84~3.76,P<0.00001)、ECMO前机械通气时间(MD=2.19,95%CI:1.48~2.90,P<0.00001)、乳酸浓度(MD=0.82,95%CI:0.32~1.31,P=0.001)、危重症评分中SAPSⅡ评分(MD=6.36,95%CI:4.01~8.71,P<0.00001)、APACHEⅡ评分(MD=2.99,95%CI:1.88~4.11,P<0.00001)、SOFA评分(MD=1.28,95%CI:0.92~1.64,P<0.00001)和ECMO上机时间(MD=1.93,95%CI:1.31~2.55,P<0.00001)与患者死亡呈负相关。结论免疫功能不全、ECMO前机械通气时间、乳酸浓度、SAPSⅡ评分、APACHEII评分、SOFA评分、ECMO上机时间是ARDS患者ECMO治疗预后的危险因素。

Objective To systematically evaluate the risk factors for the prognosis of extracorporeal membrane oxygenation in the treatment of acute respiratory distress syndrome.Methods The databases of PubMed,EMbase,Web of Science,Cochrane and CNKI were searched by computer to screen the related studies on the prognosis of ECMO in the treatment of ARDS.The retrieval time was from the establishment of the database to March 2022.Two researchers independently screened the literature,extracted the data and evaluated the included literature.The quality of the included literature was evaluated according to the bias risk assessment tool(NOS scale)of RCT,and the Revman5.4 statistical software provided by Cochrane International Collaboration was used for meta-analysis.Results A total of 31 literatures were included,including 5585 patients.The results of meta-analysis showed that immune dysfunction(OR=2.63,95%CI:1.84-3.76,P<0.00001),mechanical ventilation time before ECMO(MD=2.19,95%CI:1.48-2.90,P<0.00001),lactic acid concentration(MD=0.82,95%CI:0.32-1.31,P=0.001),SAPSⅡscore(MD=6.36,95%CI:4.01-8.71,P<0.00001),APACHEⅡscore(MD=2.99,95%CI:1.88-4.11,P<0.00001),SOFA score(MD=1.28,95%CI:0.92-1.64,P<0.00001)and ECMO time(MD=1.93,95%CI:1.31-2.55,P<0.00001)were negatively correlated with death.Conclusion Immune dysfunction,mechanical ventilation time before ECMO,lactic acid concentration,SAPSⅡscore,APACHEⅡscore,SOFA score and ECMO time are risk factors for the prognosis of ECMO in ARDS patients.