肥胖对ICU机械通气患者预后影响的系统评价

Impact of obesity on outcomes of mechanically ventilated patients in ICU:a systematic review

目的系统评价肥胖对ICU机械通气患者预后的影响。方法检索Pub Med、Embase、The Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库、中国科技期刊数据库(VIP)、中国生物医学文献数据库(CBM),纳入观察体质量指数(BMI)对ICU成年机械通气患者预后影响的病例对照研究和队列研究。对纳入文献进行偏倚风险评估和Meta分析。结果共纳入19篇文献,26 920例患者。Meta分析结果显示,肥胖组比非肥胖组患者的机械通气时间明显延长(0.29 d,95%CI 0.08~0.51,P=0.007),住院病死率(RR=0.85,95%CI 0.79~0.92,P<0.01)和长期病死率(RR=0.87,95%CI 0.81~0.93,P<0.01)明显降低。而次要结局指标如住院时间、并发症发生情况比较无统计学差异。结论 ICU肥胖患者需要更长的机械通气时间,有较低的住院病死率和长期病死率。

Objective To evaluate the effect of body mass index(BMI) on outcomes of mechanically ventilated patients in ICU. Methods Pub Med, Embase, The Cochrane Library, CBM, VIP,CNKI and Wanfang data were searched for case-control studies and cohort studies. The bias risks of included studies were assessed and the data were integrated by meta-analysis. Results Nineteen studies(n=26 920) were included in this systematic review. Meta-analysis showed that obesity was associated with a longer duration of mechanical ventilation(0.29 d, 95%CI 0.08-0.51, P=0.007), lower hospital mortality(RR=0.85, 95% CI 0.79-0.92, P <0.01) and long-term mortality(RR=0.87,95%CI 0.81-0.93, P<0.01) compared with the non-obese group. However, no significant differences in other secondary outcomes such as the length of hospital stay, the rate of complications were founded between obese and non-obese patients. Conclusions Obesity is associated with a longer duration of mechanical ventilation, lower hospital mortality and long-term mortality in ICU mechanical ventilated patients.