切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2016, Vol. 09 ›› Issue (02) : 109 -115. doi: 10.3877/cma.j.issn.1674-6880.2016.02.008

所属专题: 文献

荟萃分析

吸气阻力阀联合心肺复苏术对心脏骤停患者疗效的Meta分析
范志宽1, 柴艳芬1,(), 李晨1   
  1. 1. 300052 天津,天津医科大学总医院急诊医学科
  • 收稿日期:2015-11-11 出版日期:2016-04-01
  • 通信作者: 柴艳芬

Effect of impedance threshold device with cardiopulmonary resuscitation in heart arrest patients: a meta-analysis

Zhikuan Fan1, Yanfen Chai1,(), Chen Li1   

  1. 1. Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2015-11-11 Published:2016-04-01
  • Corresponding author: Yanfen Chai
  • About author:
    Corresponding author: Chai Yanfen, Email:
引用本文:

范志宽, 柴艳芬, 李晨. 吸气阻力阀联合心肺复苏术对心脏骤停患者疗效的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2016, 09(02): 109-115.

Zhikuan Fan, Yanfen Chai, Chen Li. Effect of impedance threshold device with cardiopulmonary resuscitation in heart arrest patients: a meta-analysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(02): 109-115.

目的

系统评价应用吸气阻力阀(ITD)联合心肺复苏术(CPR)对心脏骤停患者的疗效。

方法

计算机检索PubMed、ISI WOK平台数据库、Science Online、Nature、中文生物医学文献库(CMCC)、万方数据资源、CNKI中国知网、维普电子资源数据库中关于应用ITD和未使用ITD进行CPR的临床对照研究,检索时间为2000年至2015年6月。由2名研究者按照纳入及排除标准独立进行文献筛选、资料提取和质量评估后,采用Revman 5.3软件对数据进行Meta分析。

结果

共纳入8项研究,共包括138 992例心脏骤停患者,其中应用ITD组(ITD组)患者7 056例,未应用ITD(对照组)患者6 936例。Meta分析结果显示,自主循环恢复率两组间比较差异无统计学意义[OR=1.03,95%CI(0.96,1.11),Z=0.93,P=0.35],复苏后改良Rankin评分≤ 3的比例ITD组明显优于对照组[OR=1.74,95%CI(1.11,2.73),Z=2.40,P=0.02],复苏后存活出院率ITD组优于对照组[OR=1.40,95%CI(1.04,1.91),Z=2.18,P=0.03]。亚组分析结果显示,应用ITD联合主动胸外按压-减压心肺复苏术(ACD-CPR)(ITD + ACD-CPR)组的自主循环恢复率[OR=1.13,95%CI(1.01,1.26),Z=2.11,P=0.03]、复苏后改良Rankin评分≤ 3的比例[OR=1.53,95%CI(1.22,1.93),Z=3.67,P<0.001]及复苏后存活出院率[OR=1.25,95%CI(1.04,1.49),Z=2.38,P=0.02]均明显优于对照组。

结论

应用吸气阻力阀联合ACD-CPR可以提高心脏骤停患者心肺复苏成功率。

Objective

To assess the effect of impedance threshold device (ITD) with cardiopulmonary resuscitation (CPR) in heart arrest patients.

Methods

Systematic searches were conducted in PubMed, ISI WOK, Science Online, Nature, CMCC, Wangfang data, CNKI and VIP to collect clinical comparative study on whether to apply ITD from 2000 to June 2015. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted the data and evaluated the quality of the included studies. The meta-analysis was performed using Revman 5.3.

Results

Eight studies involving 138 992 heart arrest patients were included. There were no signifcant differences on the rate of return of spontaneous circulation (ROSC)[OR=1.03, 95%CI (0.96, 1.11), Z=0.93, P=0.35] between the two groups, but the rates of modified ranking scale (MRS) ≤ 3[OR=1.74, 95%CI (1.11, 2.73), Z=2.40, P=0.02] and the hospital discharge[OR=1.40, 95%CI (1.04, 1.91), Z=2.18, P=0.03] in the ITD group were much better than those in the control group. The subgroup analysis also implicated that compared with the control group, the rates of ROSC [OR=1.13, 95%CI (1.01, 1.26), Z=2.11, P=0.03], MRS ≤ 3 [OR=1.53, 95%CI (1.22, 1.93), Z=3.67, P<0.001] and hospital discharge[OR=1.25, 95%CI (1.04, 1.49), Z=2.38, P=0.02] in the ITD combined with active compression-decompression cardiopulmonary resuscitation (ACD-CPR) group increased obviously.

Conclusion

ITD combined with ACD-CPR can improve the success rate of CPR in heart arrest patients.

表1 纳入研究的基本资料(±s
图1 应用ITD进行心肺复苏术对自主循环恢复率影响的森林图。注:ITD:吸气阻力阀(impedance threshold device);ACD-CPR:主动胸外按压-减压心肺复苏术(active compression-decompression cardiopulmonary resuscitation);S-CPR:标准心肺复苏术(standard cardiopulmonary resuscitation)
图2 应用ITD对复苏后改良Rankin评分≤3的比例影响的森林图。注:ITD:吸气阻力阀(impedance threshold device);ACD-CPR:主动胸外按压-减压心肺复苏术(active compression-decompression cardiopulmonary resuscitation);S-CPR:标准心肺复苏术(standard cardiopulmonary resuscitation)
图3 应用ITD联合ACD-CPR对复苏后改良Rankin评分≤3比例影响的森林图。注:ITD:吸气阻力阀(impedance threshold device);ACD-CPR:主动胸外按压-减压心肺复苏术(active compression-decompression cardiopulmonary resuscitation)
图4 应用ITD进行CPR对复苏后存活出院率影响的森林图。注:ITD:吸气阻力阀(impedance threshold device);ACD-CPR:主动胸外按压-减压心肺复苏术(active compression-decompression cardiopulmonary resuscitation);S-CPR:标准心肺复苏术(standard cardiopulmonary resuscitation)
图5 应用ITD联合ACD-CPR对复苏后存活出院率影响。注:ITD:吸气阻力阀(impedance threshold device);ACD-CPR:主动胸外按压-减压心肺复苏术(active compression-decompression cardiopulmonary resuscitation)
[1]
王春飞,张广,武文卿,等.吸气阻力阀的应用与研究进展[J].生物医学工程学杂志,2014,31(2):452-457.
[2]
Luo XR, Zhang HL, Chen GJ, et al. Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis[J]. World J Emerg Med, 2013, 4 (4): 266-272.
[3]
Huffmyer JL, Groves DS, Scalzo DC, et al. The effect of the intrathoracic pressure regulator on hemodynamics and cardiac output[J]. Shock, 2011, 35 (2): 114-116.
[4]
Plaisance P, Lurie KG, Payen D. Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest[J]. Circulation, 2000, 101 (9):989-994.
[5]
Wolcke BB, Mauer DK, Schoefmann MF, et al. Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest[J]. Circulation, 2003, 108 (18): 2201-2205.
[6]
Plaisance P, Lurie KG, Vicaut E, et al. Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest[J]. Resuscitation, 2004, 61 (3): 265-271.
[7]
Aufderheide TP, Pirrallo RG, Provo TA, et al. Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest[J]. Crit Care Med, 2005, 33 (4): 734-740.
[8]
Pirrallo RG, Aufderheide TP, Provo TA, et al. Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation[J]. Resuscitation, 2005, 66 (1): 13-20.
[9]
Aufderheide TP, Frascone RJ, Wayne MA, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial[J]. Lancet, 2011, 377 (9762): 301-311.
[10]
Aufderheide TP, Nichol G, Rea TD, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest[J]. N Engl J Med, 2011, 365 (9): 798-806.
[11]
Frascone RJ, Wayne MA, Swor RA, et al. Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device[J]. Resuscitation, 2013, 84 (9): 1214-1222.
[12]
Smith SW, Parquette B, Lindstrom D, et al. An impedance threshold device increases blood pressure in hypotensive patients[J]. J Emerg Med, 2011, 41 (5): 549-558.
[13]
Convertino VA, Ryan KL, Rickards CA, et al. Optimizing the respiratory pump: harnessing inspiratory resistance to treat systemic hypotension[J]. Respir Care, 2011, 56 (6): 846-857.
[14]
Metzger A, Matsuura T, McKnite S, et al. Intrathoracic pressure regulation improves 24-hour survival in a pediatric porcine model of hemorrhagic shock[J]. Pediatr Res, 2011, 70 (3): 267-271.
[15]
Lafuente-Lafuente C, Melero-Bascones M. Active chest compression-decompression for cardiopulmonary resuscitation[J]. Cochrane Database Syst Rev, 2013 (9): CD002751.
[16]
Vigani A, Shih AC, Buckley GJ, et al. Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs[J]. J Vet Emerg Crit Care (San Antonio), 2011, 21 (6): 618-624.
[17]
Shih AC, Vigani A, Loring N, et al. Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs[J]. Vet Anaesth Analg, 2010, 37 (3): 215-221.
[18]
Thigpen K, Davis SP, Basol R, et al. Implementing the 2005 American Heart Association guidelines, including use of the impedance threshold device, improves hospital discharge rate after in-hospital cardiac arrest[J]. Respir Care, 2010, 55 (8): 1014-1019.
[19]
Pantazopoulos IN, Xanthos TT, Vlachos I, et al. Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest[J]. Crit Care Med, 2012, 40 (3): 861-868.
[20]
Mader TJ, Kellogg AR, Smith J, et al. A blinded, randomized controlled evaluation of an impedance threshold device during cardiopulmonary resuscitation in swine[J]. Resuscitation, 2008, 77 (3): 387-394.
[21]
Herff H, Raedler C, Zander R, et al. Use of an inspiratory impedance threshold valve during chest compressions without assisted ventilation may result in hypoxaemia[J]. Resuscitation, 2007, 72 (3): 466-476.
[22]
Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials[J]. JAMA, 1995, 273 (5): 408-412.
[23]
Shuster M, Lim SH, Deakin CD, et al. Part 7: CPR techniques and devices: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2010, 122 (16 Suppl 2): S338-S344.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[4] 程鹏, 杨道鸿, 邓文君, 钟宇琼, 胡晓雪, 黄小银, 周道扬. 纤维蛋白原治疗创伤性凝血病有效性和安全性的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 225-231.
[5] 沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[6] 郭仁凯, 武慧铭, 李辉宇. 机器人辅助全系膜切除术治疗右半结肠癌有效性和安全性的Meta分析及试验序贯分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 234-240.
[7] 朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[8] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[9] 高瑞, 康迪斯, 秦蘅, 胡月明, 初同伟, 代丽. 加速康复管理改善膝关节置换术后肺部感染并发症和疗效的Meta分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 234-237.
[10] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[11] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[12] 郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[13] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[14] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
[15] 陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.
阅读次数
全文


摘要