院外心肺复苏中电除颤波形选择的Meta分析:单相和双相

Defibrillation waveform selection in out-hospital patients during CPR:biphasic vs.monophasic

目的:探讨院外心肺复苏中双相波及单相波电除颤对患者预后的影响。方法:系统检索Pubmed(1966—2016.12),EMBASE(1980—2016.12)数据库,Cochrane临床研究注册中心(CENTRAL)(建库至2016.12),并网络检索及手工检索相关文献。纳入所有关于对比院外心肺复苏时双相波及单相波电除颤患者预后的随机对照研究及前瞻性队列研究。分析不同波形电除颤对患者的自主循环恢复情况(ROSC),入院时存活率,出院时存活率,1个月存活率以及出院患者神经系统恢复情况的影响。结果:纳入4篇RCT文献及3篇前瞻性队列研究文献。院外心肺复苏时双相波与单相波电除颤在ROSC上差异无统计学意义(RR=1.11,95%CI:0.91～1.36,P=0.32,I2=65%),入院存活率(RR=0.94,95%CI:0.67～1.32,P=0.72,I2=76%),出院存活率(RR=1.14,95%CI:0.84～1.54,P=0.40,I2=0),1个月存活率(RR=1.13,95%CI:0.98～1.32,P=0.10,I2=70%)以及生存患者神经系统恢复情况(RR=0.95,95%CI:0.75～1.21,P=0.69,I2=0)均差异无统计学意义。结论:虽然目前指南推荐使用双相波电除颤,但目前证据表明院外心肺复苏时使用双相波或单相波电除颤,患者预后差异无统计学意义。

Objective:To systematically review the prognosis of biphasic and monophasic waveform defibrillation in out-hospital patients with cardiac arrest.Method:We searched Pubmed(1966-2016.12),EMBASE(1980-2016.12)and CENTRAL(create detebase-2016.12),and retrieved of all the researches which compared the prognosis of biphasic and monophasic defibrillation in out-hospital patients.The outcomes including:return of spontaneous circulation(ROSC),survival at hospital admission,survival at discharge,1-month survival,and neurologic recovery in discharged patients.We pooled the original results of included studies by using standard random effects,yielding a weighted hazard ratio(RR)and a 95% confidence interval(95%CI).Result:According to the retrieval strategy.Finally,a total of 4 RCT literature and 3 prospective cohort studies were included.ROSC have no significant difference between biphasic and monophasic waveform(RR=1.11,95%CI:0.91-1.36,P=0.32,I2=65%).The survival rate of admission(RR=0.94,95%CI:0.67-1.32,P=0.72,I2=76%),the survival rate after discharge(RR=1.14,95%CI:0.84-1.54,P=0.40,I2=0),1-month survival(RR=1.13 95%CI:0.98-1.32,P=0.10 and I2=70%)and nervous system survival recovery(RR=0.95 95%CI:0.75-1.21,P=0.69;I2=0)also had no significant difference.Conclusion:The use of biphasic and monophasic wave electric defibrillation had no significant difference on the prognosis in patients with out-of hospital CPR.