两种院前急救模式抢救急性左心衰效果的系统分析  

Efficacy of two pre-hospital emergency service models for acute left heart failure patients:a systemic analysis

作　　者：胡方圆 杜茂林[1] 吴多博 王彬[1] 熊林平[2] 王九生 HU Fangyuan DU Maolin WU Duobo WANG Bin XIONG Linping WANG Jiusheng(Student Team, Faculty of Health Services, the Second Military Medical University, Shanghai, 200433 ,China Department of Health Service Management,Faculty of Health Services,the Second Military Medical University Department of Training, the Second Military Medical University)

机构地区：[1]第二军医大学卫生勤务学系学员队,上海200433 [2]第二军医大学卫生勤务学系卫生事业管理学教研室 [3]第二军医大学训练部

出　　处：《临床急诊杂志》2017年第9期695-699,共5页Journal of Clinical Emergency

摘　　要：目的:对当前两种院前急救模式治疗急性左心衰患者的效果进行系统分析,为急性左心衰患者的急救模式的选择提供参考依据。方法:检索2000-2017年维普、万方、中国知网、SinoMed、中国医师协会、PubMed和Embase数据库,纳入符合标准的文章,采用Review Manager5.3进行Meta分析,得到不同模式治疗左心衰有效率及并发症发生率合并后的OR(95%CI)及P值。结果:共纳入13篇文章,1 139例调查对象,Meta分析显示,采用"院前急救"相对于"无院前急救"模式可显著提高急性左心衰总有效率(OR=3.83,95%CI:2.45~5.97,P<0.000 01)。在"院前急救"模式中,采用"先治疗后转运"相对于"边转运边治疗"方法,也可显著提高总有效率(OR=3.11,95%CI:2.09~4.63,P<0.000 01),并且可显著提高转运过程中的安全性。结论:抢救急性左心衰患者,采用"院前急救"模式疗效优于"无院前急救"模式,同时,在"院前急救"模式中,采用"先治疗后转运"方法疗效优于"边转运边治疗"模式,并可显著减少呼吸抑制和心跳骤停并发症的发生。Objective：Make systematic analysis for the clinical efficacy of the two pre-hospital emergency service models in acute left heart failure patients saving,and provide a reference for the selection from the two pre-hospital emergency service models. Method： The cqvip, Wanfang, China National Knowledge Infrastructure, SinoMed, Chinese Medical Association,PubMed and Embase databases were searched to collected all the literatures that meet the inclusion criteria. Meta analysis was performed with Review Manager 5.3 software to obtain the combined OR （95 %CI） and P value of the efficacy of different models on left heart failure. Result.. A total of 13 articles and 1139 subjects were included. Compared to the ＂no pre-hospital emergency service＂ models,＇pre-hospital emergency service models can significantly increase the total effective rate （OR = 3.83,95 % CI：2.45 - 5.97, P〈0. 000 01）. In the pre-hospital emergency model,＇Treat before transportation＂ model ean significantly increase the total effective rate （OR = 3.11,950% CI：2, 09 -4.63,P〈0. 000 01） and ensure the transportation safety compared to the ＂Treat on the way＇ model. Conclusion：For the patients with acute left heart failure, the treatment effieacy of ＂pre-hospital emergency serviee mode is better than that of ＂no pre-hospital emergency service＂ model. At the same time, in the ＂prehospital emergency service＂ model, the efficacy of ＂Treat before transportation＂ model is better than the ＂Treat on the way＇ model in the clinical efficacy aspect. The ＂Treat on the way＇ model has a lower respiratory depression and cardiac arrest incidence than that of Treat on the way＇ model.

关 键 词：院前急救模式 急性左心衰竭 疗效 META分析 

分 类 号：R459.7[医药卫生—急诊医学]