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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

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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]. 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]. 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)
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