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, 95%CT 1. 14—1.80, P=0.002),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: cf9066@126. 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 (CMAC)(1994 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 (RR=1.32, 95% CT 1.08〜1.63, P=0.008 )・ From all over the studies there was no significant difference in reported adverse events between the normolhermia and hypothermia group (P>0. 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