亚低温治疗心搏骤停患者的疗效评价

亚低温治疗心搏骤停患者的疗效评价 【摘要】目的心搏骤停后的神经功能恢复是临床治疗的难点，实验 和临床研究表明亚低温治疗是有益的。本文通过Meta分析探讨亚低温治 疗对心搏骤停后患者的有效性和安全性。方法 检索Medline （1966年至 2012 年 4 月）、0VID （1980 年至 2012 年 4 月）、EMBASE （1980 年至 2012 年4月）、中国生物医学文献数据库（CBM） （1978年至2012年4月）、中 文生物医学期刊文献数据库（CMCC） （1995年至2012年4月）和中国医学 学术会议论文数据库（CMAC） （1994年至2012年4月）。纳入文献符合 ①随机对照试验（RCT）；②比较常温与亚低温治疗心搏骤停心肺复苏成功 的患者；③结果为神经功能恢复和出院存活。合并效应量，计算相对危险 度（RR）和95可信区间（95 CDo结果4个RCT共纳入417例心搏骤 停心肺复苏成功的患者。与常温组比较，亚低温治疗组患者神经功能恢复 更好（RR二1.43, 95CT 1. 141.80, P0.002）,出院存活更高（RR二 1.32, 95 CI 1.08-1.63, P二0.008）。所纳入文献报道的不良事件在两组间差 异无统计学意义（P〉0.05）。各研究同质性好，不存在发表偏倚。结论 亚 低温治疗改善了心搏骤停后患者的神经功能和出院存活。 【关键词】心搏骤停；心肺复苏；自主循环恢复；亚低温；神经功能; 出院存活；Meta分析；随机对照试验 The efficacy of mild hypothermia for the treatment of patients meta-analysis. WANG Xiao-ping, LIN Qing-ming, ZHAO Shen, LIN Shi-rong, CHEN Feng, Provincial Clinical College of Fujian Medical University, Fujian Provincial Emergency Centre, Fuzhou 350001, China Corresponding author CHEN Feng, Email Emai 1 cf9066126. com [Abstract] Objective To study the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from cardiac arrest using a meta-analysis. s We searched the MEDLINE 1966-April 2012, OVID 1980 to April 2012, EMBASE 1980 to April 2012, Chinese bio-medical literature retri system CBM 1978 to April 2012 , Chinese medical current contents CMCC 1995 to April 2012, and Chinese medical academic conference CMAC1994 to April 2012 . Studies were included 1 the study design was a randomized control 1ed trial RCT； 2 the study population included patients successfully resuscitated from cardiac arrest, and received either conventional post-resuscitation care with normotherinia or mild hypothermia； 3 the study provided data about good neurologic outcome and survival till hospital discharge. Relative risk RR and 95 confidence interval CI were used to pool the effect. Results The study included four RCTs with a collected total of 417 patients conventional post-resuscitation care with normothermia, patients in the hypothermia group were more likely to have good neurologic outcome RR二 1.43, 95 CI 1. 14〜1. 80, P二0.002 and were more likely to survive till hospital discharge RR1.32, 95 CT 1.08〜1.63, P0.008 ・ From all over the studies there was no significant difference in reported adverse events between the normolhermia and hypothermia group P0. 05 . There did not exist heterogeneity and publication bias. Conclusions Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from cardiac arrest. [Key words] Cardiac arrest； CardiopuImonary resuscitation； Return of spontaneous circulation； Mild hypothermia； Neurologic function； Survival to hospital discharge； Meta-analysis； Randomised controlled trial 发达国家每年院外心搏骤停发生率为36〜128 /10万[1]。我国心 脏性猝死发生率为41.8/10万，每年导致超过54. 4万人死亡[2]。院外心 搏骤停患者初始的心肺复苏成功率约为39 13〜59，但是出院生存率 仅占复苏患者4. 6[3]O因此，心搏骤停后前几个小时的治疗是非常关键 的。 对于心搏骤停复苏后患者