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中华危重症医学杂志(电子版) ›› 2019, Vol. 12 ›› Issue (03) : 163 -168. doi: 10.3877/cma.j.issn.1674-6880.2019.03.004

所属专题: 文献

荟萃分析

气管内插管与声门上气道放置对院外心脏骤停患者心肺复苏疗效的Meta分析
寇卜今1, 陈碧华2, 廖雪丽1, 廖富团1, 朱妮1, 周满红1,()   
  1. 1. 563003 贵州遵义,遵义医科大学附属医院急诊科
    2. 400000 重庆,陆军军医大学生物医学工程与影像学系
  • 收稿日期:2019-02-20 出版日期:2019-06-01
  • 通信作者: 周满红
  • 基金资助:
    国家自然科学基金青年科学基金项目(81701300); 贵州省研究生教育创新计划项目(黔教合YJSCXJH〔2018〕092); 遵义医学院临床学院教改项目(2017023)

Outcomes of cardiopulmonary resuscitation between endotracheal intubation and supraglottic airway placement for patients with out-of-hospital cardiac arrest: a meta- analysis

Bojin Kou1, Bihua Chen2, Xueli Liao1, Futuan Liao1, Ni Zhu1, Manhong Zhou1,()   

  1. 1. Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
    2. Department of Biomedical Engineering and Imaging, Army Medical University, Chongqin 400000, China
  • Received:2019-02-20 Published:2019-06-01
  • Corresponding author: Manhong Zhou
  • About author:
    Corresponding author: Zhou Manhong, Email:
引用本文:

寇卜今, 陈碧华, 廖雪丽, 廖富团, 朱妮, 周满红. 气管内插管与声门上气道放置对院外心脏骤停患者心肺复苏疗效的Meta分析[J]. 中华危重症医学杂志(电子版), 2019, 12(03): 163-168.

Bojin Kou, Bihua Chen, Xueli Liao, Futuan Liao, Ni Zhu, Manhong Zhou. Outcomes of cardiopulmonary resuscitation between endotracheal intubation and supraglottic airway placement for patients with out-of-hospital cardiac arrest: a meta- analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(03): 163-168.

目的

综合评价并探讨院前气管内插管(ETI)与声门上气道(SGA)放置对院外心脏骤停(OHCA)患者的心肺复苏疗效。

方法

检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库、中国知网、万方数据库从建库至2018年9月8日以来关于对比由急诊医疗服务系统(EMSS)人员实施的ETI和SGA高级气道管理对OHCA患者心肺复苏效果的相关文献。由2位研究者按照纳入及排除标准独立进行文献筛选、数据提取及质量评价后,采用RevMan 5.3软件进行Meta分析。

结果

共纳入13篇队列研究,1篇随机对照试验,包括了40 063例ETI患者和47 897例SGA患者。Meta分析结果显示,ETI组患者的自主循环恢复率[比值比(OR)= 1.20,95%置信区间(CI)(1.06,2.51),Z=2.98,P=0.003]及出院后神经系统功能完整性[OR=1.09,95%CI(1.01,1.19),Z=2.09,P=0.04]明显高于SGA组患者,而ETI组与SGA组患者间入院存活率[OR=1.14,95%CI(1.00,1.30),Z=1.97,P=0.05]及出院存活率[OR=1.04,95%CI(0.97,1.12),Z=1.16,P=0.25]比较,差异均无统计学意义。

结论

对于由EMSS人员操作的成人OHCA患者的心肺复苏中气道管理而言,使用ETI优于SGA。

Objective

To evaluate the outcome of cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) patients who received endotracheal intubation (ETI) or supraglottic airway (SGA) placement.

Methods

Systematic searches were conducted in Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang data to collect studies comparing ETI and SGA performed by emergency medical service system (EMSS) staff for patients with OHCA published up to September 8, 2018. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.3 software.

Results

Thirteen cohort studies and one randomized controlled trial with 40 063 ETI patients and 47 897 SGA patients were enrolled. Meta-analysis demonstrated that the return of spontaneous circulation [odds ratio (OR)=1.20, 95% confidence interval (CI) (1.06, 2.51), Z=2.98, P=0.003] and neurologically intact survival after hospital discharge [OR=1.09, 95%CI (1.01, 1.19), Z=2.09, P=0.04] in the ETI group were much better than those in the SGA group. However, there were no significant differences in the admission survival rate [OR=1.14, 95%CI (1.00, 1.30), Z=1.97, P=0.05] and discharge survival rate [OR=1.04, 95%CI (0.97, 1.12), Z=1.16, P=0.25] between the two groups.

Conclusion

ETI performed by EMSS staff for patients with OHCA is much better than SGA.

图1 ETI组与SGA组对院外心脏骤停患者自主循环恢复率的森林图
图2 ETI组与SGA组对院外心脏骤停患者入院存活率的森林图
图3 ETI组与SGA组对院外心脏骤停患者出院存活率的森林图
图4 ETI组与SGA组对院外心脏骤停患者出院后神经系统功能完整性的森林图
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