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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01) : 48 -59. doi: 10.3877/cma.j.issn.1674-6880.2023.01.009

荟萃分析

静脉-动脉体外膜肺氧合联合主动脉内球囊反搏对心源性疾病患者病死率的影响：Meta分析
陈婧1, 姚杨2, 苗继荣1, 丁格1, 马青1, 彭伊梦1, 卢洲1, 康凤尔1, 王胜昱2,†()   
  1. 1. 710077　西安，西安医学院第一附属医院全科
    2. 710077　西安，西安医学院第一附属医院呼吸与危重症医学科
  • 收稿日期:2022-09-21 出版日期:2023-02-28
  • 通信作者: 王胜昱
  • 基金资助:
    2020年西安市第七批科技计划项目(20YXYJ0001（7）); 医学科研发展基金项目临床与基础研究专项(B21021BN); 西安医学院呼吸与危重症疾病的基础与转化研究创新团队(2021TD13)

Effect of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pumping on mortality in patients with cardiogenic diseases: a meta-analysis

Jing Chen1, Yang Yao2, Jirong Miao1, Ge Ding1, Qing Ma1, Yimeng Peng1, Zhou Lu1, Fenger Kang1, Shengyu Wang2,†()   

  1. 1. Department of General Medicine, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
    2. Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
  • Received:2022-09-21 Published:2023-02-28
  • Corresponding author: Shengyu Wang
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陈婧, 姚杨, 苗继荣, 丁格, 马青, 彭伊梦, 卢洲, 康凤尔, 王胜昱. 静脉-动脉体外膜肺氧合联合主动脉内球囊反搏对心源性疾病患者病死率的影响：Meta分析[J]. 中华危重症医学杂志(电子版), 2023, 16(01): 48-59.

Jing Chen, Yang Yao, Jirong Miao, Ge Ding, Qing Ma, Yimeng Peng, Zhou Lu, Fenger Kang, Shengyu Wang. Effect of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pumping on mortality in patients with cardiogenic diseases: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(01): 48-59.

目的

系统评价静脉-动脉体外膜肺氧合（VA-ECMO）联合主动脉内球囊反搏（IABP）对心源性疾病患者病死率的影响。

方法

计算机检索PubMed、The Cochrane Library、Embase、Web of Science、万方、知网和中国生物医学文献数据库自建库至2022年4月发表的关于VA-ECMO联合IABP治疗心源性疾病患者的相关研究。由2名研究员独立筛选文献、提取数据及质量评价后，应用Stata 17软件进行Meta分析。

结果

共纳入84篇研究、15 528例患者，其中8 520例患者接受了VA-ECMO联合IABP治疗（试验组），7 008例患者为单纯VA-ECMO治疗（对照组）。Meta分析显示，试验组患者的入院30 d/住院病死率[风险比（RR） = 0.86，95%置信区间（CI）（0.83，0.89），Z = 8.64，P < 0.000 01]及神经系统并发症的发生率[RR = 0.70，95%CI（0.54，0.90），Z = 2.78，P = 0.005]较对照组均显著降低，ECMO脱机率[RR = 1.35，95%CI（1.28，1.42），Z = 11.89，P < 0.000 01]较对照组显著提高。亚组分析显示，与对照组比较，试验组心脏相关混合疾病[RR = 0.85，95%CI（0.81，0.90），Z = 5.99，P < 0.000 01]、急性冠状动脉综合征（ACS）[RR = 0.68，95%CI（0.63，0.74），Z = 9.21，P < 0.000 01]患者的入院30 d/住院病死率及混合神经系统并发症的发生率[RR = 0.58，95%CI（0.40，0.84），Z = 2.90，P = 0.004]均显著降低，心脏切开术后[RR = 1.22，95%CI（1.10，1.34），Z = 3.88，P = 0.000 1]及心脏相关混合疾病[RR = 1.45，95%CI（1.37，1.53），Z = 12.51，P < 0.000 01]患者的ECMO脱机率均显著提高。

结论

VA-ECMO联合IABP相较于单独使用VA-ECMO可以降低心脏相关混合疾病及ACS患者的入院30 d/住院病死率，增加心脏切开术后及心脏相关混合疾病患者的ECMO脱机率，并可能减少混合神经系统并发症的发生。

关键词: 体外膜肺氧合, 主动脉球囊反搏, 病死率, 心源性疾病, Meta分析
Objective

To systematically evaluate the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pumping (IABP) on the mortality of patients with cardiogenic diseases.

Methods

Systematic searches were conducted in PubMed, the Cochrane Library, Embase, Web of Science, Wanfang data, CNKI and CBM to collect articles about using VA-ECMO combined with IABP to treat patients with cardiogenic diseases published up to April 2022. Two reviewers independently screened articles, extracted data and evaluated quality, and then the meta-analysis was performed using Stata 17 software.

Results

A total of 15 528 patients were enrolled in 84 studies, of which 8 520 patients received VA-ECMO combined with IABP (experimental group) and 7 008 patients only received VA-ECMO (control group). Meta-analysis showed that as compared with the control group, the 30-d mortality/inpatient mortality [relative risk (RR) = 0.86, 95% confidence interval (CI) (0.83, 0.89), Z = 8.64, P < 0.000 01] and the incidence of neurological complications [RR = 0.70, 95%CI (0.54, 0.90), Z = 2.78, P = 0.005] decreased remarkably, and the success rate of weaning from ECMO [RR = 1.35, 95%CI (1.28, 1.42), Z = 11.89, P < 0.000 01] increased obviously in the experimental group. Subgroup analysis showed that the 30-d mortality/inpatient mortality in patients with heart-related mixed diseases [RR = 0.85, 95%CI (0.81, 0.90), Z = 5.99, P < 0.000 01] and in patients with acute coronary syndrome (ACS) [RR = 0.68, 95%CI (0.63, 0.74), Z = 9.21, P < 0.000 01] and the incidence of mixed neurological complications [RR = 0.58, 95%CI (0.40, 0.84), Z = 2.90, P = 0.004] were much lower, and the success rate of weaning from ECMO in patients with postcardiotomy [RR = 1.22, 95%CI (1.10, 1.34), Z = 3.88, P = 0.000 1] and heart-related mixed diseases [RR = 1.45, 95%CI (1.37, 1.53), Z = 12.51, P < 0.000 01] were much higher in the experimental group than those in the control group.

Conclusion

Compared with VA-ECMO alone, VA-ECMO combined with IABP can reduce 30-d mortality/inpatient mortality in patients with heart-related mixed diseases and ACS, increase the success rate of weaning from ECMO in patients with postcardiotomy and heart-related mixed diseases, and reduce mixed neurological complications.

Key words: Extracorporeal membrane oxygenation, Intra-aortic balloon pumping, Mortality, Cardiogenic disease, Meta-analysis
图1 两组心源性疾病患者短期病死率比较的森林图注：ACS.急性冠状动脉综合征；RR.相对危险度；CI.置信区间
图2 两组心源性疾病患者ECMO脱机率比较的森林图注：ECMO.体外膜肺氧合；ACS.急性冠状动脉综合征；RR.相对危险度；CI.置信区间
图3 两组心源性疾病患者神经系统并发症比较的森林图注：RR.相对危险度；CI.置信区间
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