体外膜肺氧合在重症急性心肌梗死救治中的应用效果:Meta分析  

Effects of extracorporeal membrane oxygenation on the treatment in patients with severe myocardial infarction:a Meta analysis

作　　者：汪雁博[1] 姜云发[1] 郝国贞[1] 谷新顺[1] WANG Yanbo;JIANG Yunfa;HAO Guozhen;GU Xinshun(Department of Cardiology,The Second Hospital of Hebei Medical University,Shijiazhuang,050000,China)

机构地区：[1]河北医科大学第二医院心血管内五科,石家庄050000

出　　处：《临床心血管病杂志》2021年第6期525-530,共6页Journal of Clinical Cardiology

基　　金：河北省2019年度医学科学研究课题计划(No:20190523)。

摘　　要：目的:评价体外膜肺氧合(ECMO)在重症急性ST段抬高型心肌梗死(STEMI)救治中的应用效果。方法:检索PubMed、维普、万方和中国知网等数据库中所有已经发表的关于ECMO辅助治疗STEMI并发心源性休克或心脏骤停的观察性研究和对比研究。检索时间为各数据库创建至2019年10月,语言不限。有效性指标包括:成功撤机的比例;住院期间存活率;出院1个月存活率。安全性指标包括:并发症的总发生率;神经系统损伤的发生率;急性肾损伤或行连续肾脏替代疗法(CRRT)的比例;下肢缺血比例;出血、血肿发生率。使用Stata 12.0软件进行分析。结果:最终入选研究17项,共计患者505例。Meta结果显示,应用ECMO辅助治疗后成功撤机比例为0.63[95%CI:(0.45,0.80)],院内生存率为0.53[95%CI:(0.35,0.70)],1个月内生存率为0.63[95%CI:(0.49,0.77)];并发症总体发生率为0.38[95%CI:(0.24,0.52)],神经系统损伤发生率为0.12[95%CI:(0.01,0.20)],急性肾损伤或行CRRT比例为0.41[95%CI:(0.20,0.62)],下肢缺血发生率为0.06[95%CI:(0.02,0.10)],出血和血肿发生率为0.20[95%CI:(0.05,0.35)]。结论:应用ECMO辅助救治并发心源性休克或心脏骤停复苏的重症STEMI具有良好的效果和安全性。Objective:To evaluate the effects of extracorporeal membrane oxygenation(ECMO)on the treatment in patients with severe myocardial infarction.Methods:Both foreign and Chinese databases,including PubMed,VIP,Wanfang,and CNKI,were searched to clinical trials that reported the effects of ECMO on the severe ST-segment elevation myocardial infarction(STEMI)from the establishment of each database to October 2019 and the language was not limited.The effective indicators included the rate of successful weaning,the survival rate during hospitalization,and the one-month survival rate after discharge.The safety indicators included the overall incidence of complications,the incidence of nervous system injury,acute kidney injury or continuous renal replacement therapy(CRRT),the rate of lower limb ischemia,and the incidence of hemorrhage and hematoma.Stata 12.0 was used to perform the Meta analysis.Results:Seventeen studies with 505 patients were included.The Meta analysis showed that the rate of successful weaning was 0.63(95%CI:[0.45,0.80]),the in-hospital survival rate was 0.53(95%CI:[0.35,0.70]),and the one-month survival rate was 0.63(95%CI[0.49,0.77]);The overall incidence of complications was 0.38(95%CI:[0.24,0.52]),the incidence of neurological injury was 0.12(95%CI:[0.01,0.20]),and the rate of acute kidney injury or CRRT was 0.41(95%CI:[0.20,0.62]),the incidence of lower limb ischemia was 0.06(95%CI:[0.02,0.10]),the incidence of hemorrhage and hematoma was 0.20(95%CI:[0.05,0.35]).Conclusion:ECMO is effective and safe in the treating severe STEMI complicated with cardiogenic shock or cardiac arrest.

关 键 词：体外膜肺氧合 ST段抬高型心肌梗死 心源性休克 心脏骤停 

分 类 号：R542.2[医药卫生—心血管疾病]