体外膜氧合在新型冠状病毒感染患者中的作用:队列研究的系统评价和Meta分析  

The application of extracorporeal membrane oxygenation in patients with COVID-19:a systematic review and meta-analyses of cohort studies

作　　者：苏懿 马明远 郭倩倩 郭力恒 SU Yi;MA Mingyuan;GUO Qianqian;GUO Liheng(Department of Intensive Unit Care,Foshan Hospital of TCM Affiliated with Guangzhou University of Chinese Medicine,Foshan 528000,P.R.China;Department of Breast,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong 510000,P.R.China;Department of Intensive Unit Care,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510000,P.R.China)

机构地区：[1]广州中医药大学附属佛山中医院重症医学科,广东佛山528000 [2]广州中医药大学第二附属医院乳腺科,广州510000 [3]广州中医药大学第二附属医院重症医学科,广州510000

出　　处：《中国循证医学杂志》2021年第7期803-809,共7页Chinese Journal of Evidence-based Medicine

基　　金：广东省自然科学基金项目(编号:2017A030313725);佛山市科技创新项目医学类科技公关项目(编号:1920001000307);佛山市卫生局医学科研项目(编号:20210169);2020年度佛山市竞争性扶持人才项目。

摘　　要：目的系统评价体外膜氧合(extracorporeal membrane oxygenation,ECMO)在新型冠状病毒(COVID-19)感染患者中的作用。方法计算机检索PubMed、The Cochrane Library、EMbase、CBM、WanFang Data和CNKI数据库,搜集有关ECMO治疗COVID-19患者的临床研究,检索时限均从2019年12月1日至2020年12月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入24个研究,包括COVID-19所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者1576例。患者总体死亡率为27.3%(430/1576),接受ECMO治疗率为4.68%(379/1576),经ECMO治疗后患者存活率为69.4%(263/379)。ARDS患者经ECMO治疗前机械通气平均时间在2.07±0.40到15.89±13.0天之间,而接受ECMO治疗的平均时间范围在1.64±0.78天和29.9±3.60天之间。纳入Meta分析的11个研究中,84.0%(405/482)的COVID-19所致ARDS患者接受常规治疗,其中16.0%(77/482)在ARDS常规治疗基础上联合ECMO治疗。Meta分析结果显示,ARDS常规治疗联合ECMO治疗和单用ARDS常规治疗对COVID-19所致ARDS患者的存活率差异具有统计学意义[RR=1.27,95%CI(1.00,1.62),P=0.05]。结论目前有限证据显示,COVID-19患者经ECMO治疗后其存活率有提高的趋势。受纳入研究数量和质量限制,上述结论仍需开展更多高质量研究予以验证。Objective To systematically review the application of extracorporeal membrane oxygenation(ECMO)in patients with coronavirus disease 2019(COVID-19).Methods PubMed,The Cochrane Library,EMbase,CBM,WanFang Data and CNKI databases were searched for studies on ECMO for COVID-19 from December 1st,2019 to December 31st,2020.Two researchers independently screened literature,extracted data,and evaluated the risk of bias of included studies.Meta-analysis was then performed using RevMan 5.3 software.Results A total of 24 studies were included,involving 1576 acute respiratory distress syndrome(ARDS)patients with COVID-19.The overall mortality of patients was 27.3%(430/1576).The rate of ECMO treatment was 4.68%(379/1576),and the survival rate was 69.4%(263/379).The mean duration of mechanical ventilation prior to ECMO treatment for ARDS patients ranged from 2.07±0.40 to 15.89±13.0 days,compared with 1.64±0.78 days and 29.9±3.60 days for ECMO treatment.Of the 11 studies included in the meta-analysis,84.0%(405/482)patients with ARDS received conventional treatment with COVID-19,and 16.0%(77/482)received ECMO treatment on the basis of conventional treatment with ARDS.Results of meta-analysis showed that there was statistically significant difference in the survival rate of ARDS patients with COVID-19 treated with conventional therapy combined with ECMO or with conventional therapy alone(RR=1.27,95%CI 1.00 to 1.62,P=0.05).Conclusions This study suggests that the survival rate of COVID-19 patients after ECMO treatment has a tendency to improve.Due to the limitation of quantity and quality of included studies,the above conclusions are needed to be verified by more high-quality studies.

关 键 词：新型冠状病毒 体外膜氧合 急性呼吸窘迫综合征 常规治疗 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]