远端灌注导管对VA-ECMO患者肢体缺血和预后影响的Meta分析  

Distal perfusion cannulae in preventing limb ischemia in venous-arterial extracorporeal membrane oxygenation:a Meta-analysis

作　　者：张晓玲 方强[1] 陈琨[2] Zhang Xiaoling;Fang Qiang;Chen Kun(Department of Critical Care Medicine,the First Affiliated Hospital of Zhejiang University,Hangzhou 310003,Zhejiang,China;Department of Critical Care Medicine,Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第一医院重症医学科,杭州310003 [2]金华市中心医院重症医学科,浙江金华321000

出　　处：《中华危重病急救医学》2020年第11期1361-1366,共6页Chinese Critical Care Medicine

基　　金：浙江省医药卫生科研项目(2017KY686)。

摘　　要：目的观察远端灌注导管(DPC)对静脉-动脉体外膜肺氧合(VA-ECMO)动脉导管相关性肢体缺血发生率和预后的影响。方法系统检索中国知网(CNKI)、万方医学数据库、美国国立医学图书馆(PubMed)数据库、荷兰医学文摘Embase系统、Scopus数据库、Cochrane图书馆、Google学术等中英文数据库从建库至2019年2月发表的有关DPC对VA-ECMO患者动脉导管相关性肢体缺血影响的文献,检索词为体外膜肺氧合、肢体缺血、limb ischemia、extracorporeal membrane oxygenation、distal perfusion cannula。结局指标包括肢体缺血发生率和病死率。由2名评价员按纳入与排除标准选择文献,提取资料。应用RevMan 5.3软件进行Meta分析;采用敏感性分析检验Meta分析结果的稳定性;采用漏斗图分析发表偏倚。结果共纳入17篇文献,其中11篇为病例系列研究、2篇为技术描述研究、4篇为回顾性队列研究,共1850例患者,其中预防性置入DPC 1180例,未预防性置入DPC 670例。Meta分析显示,与未预防性置入DPC组比较,预防性置入DPC组肢体缺血发生率明显降低〔相对危险度(RR)=0.48,95%可信区间(95%CI)为0.37~0.62,P<0.0001〕,但两组间病死率比较差异无统计学意义〔优势比(OR)=1.41,95%CI为0.70~2.87,P<0.0005〕。漏斗图分析显示,纳入文献分布基本对称,提示发表偏倚较小。结论预防性置入DPC可降低VA-ECMO患者动脉导管相关肢体缺血发生率,但对病死率无影响。由于研究数量较少,且存在研究人群异质性等因素的影响,仍需要进行更多大样本、高质量的随机对照试验(RCT)进一步证实。Objective To evaluate the effect of distal perfusion catheter(DPC)on the incidence and prognosis of venous-arterial extracorporeal membrane pulmonary oxygenation(VA-ECMO)arterial catheter-related limb ischemia.Methods Literatures on the effect of DPC on catheter-related limb ischemia in VA-ECMO patients in Chinese and English databases such as CNKI,Wanfang Medical Database,PubMed,Embase,Scopus,Cochrane Library and Google Scholar were searched from building the database to February 2019.Keywords were extracorporeal membrane oxygenation,limb ischemia,extracorporeal membrane oxygenation,distal perfusion cannula.Outcome indicators included the incidence of limb ischemia and mortality.Two reviewers selected documents according to the inclusion and exclusion criteria,extracted data,and applied RevMan 5.3 software for Meta-analysis.Sensitivity analysis was used to test the stability of the Meta-analysis results,and funnel chart analysis was used to analyze publication bias.Results There were totally 17 articles selected for review,including 11 series studies,2 technical description studies and 4 retrospective cohort studies.Totally 1850 patients,including 1180 patients who had already received DPC in preventing limb ischemia,670 patients who had not received DPC.Meta-analysis showed that compared to no DPC,the presence of DPC could reduce the incidence of limb ischemia[relative risk(RR)=0.48,95%confidence interval(95%CI)was 0.37-0.62,P<0.0001].However,there was no significant difference in mortality between the two groups[odds ratio(OR)was 1.41,95%CI was 0.70-2.87,P<0.0005].Sensitivity analysis excluded the effect of heterogeneity on statistical results.Funnel plot showed that the distribution of the included literatures was basically symmetrical,indicating a small publication bias.Conclusions DPC can reduce the incidence of catheter-related limb ischemia in patients with VA-ECMO.Due to the small amount of studies and the influence of population heterogeneity and other factors,more large-sample and high-quality randomiz

关 键 词：体外膜肺氧合 肢体缺血 远端灌注导管 病死率 

分 类 号：R459.7[医药卫生—急诊医学]