药物预防和治疗ICU获得性肌无力效果的Meta分析  

Evaluation of pharmaceutical prevention and treatment of intensive care unit-acquired weakness:a Meta-analysis

作　　者：杨丽平[1] 张志刚[1] 张彩云[2] 田金徽[3] 马晓佳[4] 孟文勃[5] 丁楠楠 姚丽 魏花萍[2] 申希平[6] Yang Liping;Zhang Zhigang;Zhang Caiyun;Tian Jinhui;Ma Xiaojia;Meng Wenbo;Ding Nannan;Yao Li;Wei Huaping;Shen Xiping(Department of Critical Care Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu,China;Department of Nursing,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu,China;Evidence-Based Medicine Center,Lanzhou University,Lanzhou 730000,Gansu,China;Lanzhou Library,Chinese Academy of Sciences,Lanzhou 730000,Gansu,China;Department of Science Research and Development Planning,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu,China;School of Public Health,Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]兰州大学第一医院重症医学科,兰州730000 [2]兰州大学第一医院护理部,兰州730000 [3]兰州大学循证医学中心,兰州730000 [4]中国科学院兰州文献情报中心,兰州730000 [5]兰州大学第一医院科研与发展规划处,兰州730000 [6]兰州大学公共卫生学院,兰州730000

出　　处：《中华危重病急救医学》2020年第3期357-361,共5页Chinese Critical Care Medicine

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2019-46)。

摘　　要：目的:采用系统评价的方法,分析药物预防和治疗重症监护病房获得性肌无力(ICU-AW)的效果。方法:检索中国生物医学文献服务系统(SinoMed)、中国知网(CNKI)、万方数据、美国国立医学图书馆PubMed、Cochrane图书馆、科学网(Web of Science)、荷兰医学文摘EMbase等数据库,从建库至2019年5月30日发布的有关药物预防和治疗ICU-AW效果的随机对照试验(RCT),同时追溯纳入研究的参考文献。干预组采用药物预防或治疗ICU-AW;对照组采用其他康复手段进行预防或治疗。由2名研究者独立按照纳入和排除标准进行文献筛选、数据提取和质量评价。采用Stata 12.0软件进行Meta分析;仅纳入1项研究时只进行描述性分析。结果:最终纳入11项RCT,纳入患者中干预组1865例,对照组1894例。质量评价结果显示,4项研究为A级,7项研究为B级,说明纳入文献整体质量较高。Meta分析合并结果显示,强化胰岛素治疗可以预防ICU-AW的发生〔相对危险度(RR)=0.761,95%可信区间(95%CI)为0.662~0.876,P=0.000〕,但会减少苯丙氨酸损失(nmol·100 mL^-1·min^-1:-3±3比-11±3,P<0.05)和谷氨酰胺摄取(nmol·100 mL^-1·min^-1:-97±22比-51±13,P<0.05);生长激素、谷氨酰胺、右美托咪定、新斯的明、氧甲氢龙和静脉注射用免疫球蛋白在预防及治疗ICU-AW方面与对照组比较并未显示出明显优势。结论:强化胰岛素治疗能预防ICU患者发生ICU-AW,但会增加低血糖的发生风险;生长激素、谷氨酰胺、右美托咪定、新斯的明、氧甲氢龙和静脉注射用免疫球蛋白在预防及治疗ICU-AW方面未见明显优势,目前尚无药物被推荐用于预防和治疗ICU-AW。Objective To evaluate the effect of preventing and treatment of pharmaceuticals on intensive care unit-acquired weakness(ICU-AW)by systematic review.Methods The randomized controlled trials(RCTs)concerning pharmaceutical prevention and treatment about ICU-AW in SinoMed,CNKI,Wanfang data,PubMed,Cochrane Library,Web of Science,EMbase,and other sources were searched from their foundation to May 30th,2019.The patients in the intervention group were treated with drugs to prevent or treat ICU-AW;and those in control group were treated with other rehabilitation methods.Data searching,extracting and quality evaluation were assessed by two reviewers independently.Stata 12.0 software was then used for Meta-analysis.Only descriptive analysis was conducted when only one study was enrolled.Results A total of 11 RCTs were enrolled with 1865 patients in the intervention group and 1894 in the control group.The results of quality evaluation showed that 4 studies were A-level and 7 studies were B-level,indicating that the overall quality of the enrolled literature was high.Meta-analysis showed that intensive insulin therapy could prevent ICU-AW[relative risk(RR)=0.761,95%confidence interval(95%CI)was 0.662-0.876,P=0.000],but reduced phenylalanine loss(nmol·100 mL^-1·min^-1:-3±3 vs.-11±3,P<0.05)and glutamine intake(nmol·100 mL^-1·min^-1:-97±22 vs.-51±13,P<0.05).There was no significant difference in the prevention and treatment of ICU-AW between other drugs(including growth hormone,glutamine,dexmedetomidine,neostigmine,oxandrolone,and intravenous immunoglobulin)and control group.Conclusions Intensive insulin therapy can prevent ICU-AW,but the risk of hypoglycemia will increase.Other drugs including growth hormone,glutamine,dexmedetomidine,neostigmine,oxandrolone,and intravenous immunoglobulin have no obvious advantages in the prevention and treatment of ICU-AW,so no drug has been recommended to prevent and treat ICU-AW.

关 键 词：药物 重症监护病房获得性肌无力 随机对照试验 META分析 系统评价 

分 类 号：R74[医药卫生—神经病学与精神病学]