神经肌肉阻滞剂对急性呼吸窘迫综合征患者预后影响的荟萃分析  

The effect of neuromuscular blocking agents on prognosis of patients with acute respiratory distress syndrome： a meta analysis

作　　者：王爱田[1] 高景利[1] 李晓岚[1] 冷玉鑫[2] 姚智渊[2] 朱曦[2] 

机构地区：[1]开滦总医院ICU,河北唐山063000 [2]北京大学第三医院ICU ,100191

出　　处：《中华危重病急救医学》2013年第3期149-153,共5页Chinese Critical Care Medicine

基　　金：基金项目：首都医学发展科研基金资助（2009-1014）

摘　　要：目的系统评价神经肌肉阻滞剂（NMBA）对急性呼吸窘迫综合征（ARDS）患者预后的影响。方法通过检索美国国家医学图书馆PubMed数据库、Cochrane临床试验数据库、生物医学与药理学文摘数据库（EMBASE）、荷兰《医学文摘》、中国生物医学文献数据库（CBM）和中国期刊网全文数据库（CNKI）等文献数据库，系统收集全世界范围内NMBA治疗ARDS患者的随机对照临床试验（RCT）文献。按Cochrane系统评价方法筛选试验、评价质量、提取资料，采用RevMan5．0软件进行meta分析。结果最终纳入符合入选标准的文献3篇，共计研究对象431例患者。合并结果显示：与对照组比较，给予NMBA可显著降低ARDS患者28d病死率[Peto比值比（OR）=0．57，95％可信区间（95％CI）为0．37～0．88，P=0．01]，有较少的气压伤发生率（OR=0．42，95％CI为0．20～0．91，P=0．003）；获得性肌无力的发生率与对照组比较相似，无统计学意义（OR=1．20，95％CI为0．67—2．14，P=0．54）。与对照组比较，在应用NMBA后48h，总PEEP（OR=0．09，95％CI为-0．50-0．68，P=0．77）、平台压（Pplat，OR=0．62，95％CI为-0．32～1．57，P=0．20）呼吸机相关参数无明显统计学差异；各试验组间统计学无异质性（P〉0．1，I^2〈50％）；在应用NMBA后120h，总PEEP较对照组降低（OR=-1．22，95％CI为-2．39--0．04，P=0．04），Polat与对照组比较有统计学差异（OR=-2．61，95％CI为-4．50～-0．73，P=0．007）。结论早期应用NMBA治疗ARDS患者能降低患者28d病死率，改善预后。Objective To determine the effects of neuromuscular blocking agent （NMBA） on prognosis of patients with acute respiratory distress syndrome （ARDS）. Methods PubMed database, the Cochrane Library, EMBASE, Excepta Media, CBM, CNKI and other sources were used for retrieving the pertinent literature. All randomized controlled trials （RCTs） on NMBA treating ARDS patients were enrolled. The Cochrance Collaboration＇s software RevMan 5.0 was used for data analysis. Two authors independently extracted data and assessed study quality using standardized instruments. Results Three studies were included in the final analysis, providing a sample of 431 patients. The combined results demonstrated a decrease in 28 days mortality [Peto odds ratio （OR） =0.57, 95% confidence interval （95% CI） 0.37-0.88, P= 0.01 ] and lower incidence of barotrauma （ OR = 0.42, 95% CI 0.20-0.91, P= 0.003 ） after NMBA treatment for patients with ARDS as compared with control group. The incidence of acquired neuromyopathy was similar between NMBA group and control group （OR = 1.20, 95% CI0.67-2.14, P= 0.54）. As compared with the control group at 48 hours, there was no statistical difference in ventilator parameters including total positive end expiratory pressure （PEEP, OR=0.09, 95%CI-0.50-0.68, P=0.77） and plateau pressure （Pplat, OR=0.62, 95%CI -0.32-1.57, P=0.20）. There was no heterogeneity （P〉0.1, I^2〈50%）. At 120 hours after NMBA treatment, the total PEEP was significantly lower than that of control group （OR=-1.22, 95%CI -2.39 to -0.04, P=0.04）, and the difference in Pplat showed statistical difference compared with the control group （OR=-2.61, 95%CI-4.50 to -0.73, P= 0.007）. Conclusion Early administration of NMBA for ARDS patients results in a significant reduction in 28 days mortality, and it improves outcome.

关 键 词：急性呼吸窘迫综合征 随机对照临床试验 神经肌肉阻滞剂 系统评价 

分 类 号：R563.8[医药卫生—呼吸系统]