复苏性主动脉球囊阻断术与复苏性剖胸术治疗不可压迫性躯干出血预后的Meta分析  

Resuscitation aortic balloon occlusion and resuscitation thoracotomy in the treatment of non-compressible torso hemorrhage:a Meta-analysis

作　　者：黄虹皓 杨柯 吴西强 吴松 刘建 张近宝 Huang Honghao;Yang Ke;Wu Xiqiang;Wu Song;Liu Jian;Zhang Jinbao(Southwest Jiaotong University School of Medicine,Chengdu 610031,China;Department of Cardiovascular Surgery,General Hospital of Western Theater of PLA,Chengdu 610083,China)

机构地区：[1]西南交通大学医学院,成都610031 [2]中国人民解放军西部战区总医院心胸外科,成都610083

出　　处：《中华创伤杂志》2021年第12期1112-1118,共7页Chinese Journal of Trauma

摘　　要：目的系统比较复苏性主动脉球囊阻断术(REBOA)与复苏性剖胸术(RT)治疗不可压迫性躯干出血(NCTH)的预后。方法通过计算机检索MEDLINE、EMBASE、PubMed、万方数据库、中国知网、维普期刊数据库,收集REBOA与RT治疗NCTH患者预后比较的文献。检索时限为建库至2020年12月的相关文献。由2名研究者按照纳入与排除标准独立进行文献筛选、资料提取与质量评价后,采用Revman 5.3软件进行Meta分析。根据入院时对患者所采取的治疗方式将其分为REBOA组与RT组,并对各组的预后程度进行评价,观察REBOA与RT治疗NCTH患者的病死率、术后剖腹手术再发生率、术后栓塞手术发生率、手术区域病死率差异。采用Egger法检测发表偏倚。结果纳入2篇前瞻性研究和4篇回顾性研究,共2588例研究对象,其中REBOA组1591例,RT组997例。在病死率(I^(2)=68%,OR=0.33,95%CI 0.26~0.42,P<0.01)、术后剖腹手术再发生率(I^(2)=76%,OR=1.41,95%CI 1.11~1.77,P<0.01)和术后栓塞手术发生率(I^(2)=84%,OR=0.76,95%CI 0.59~0.99,P<0.05)方面,REBOA组与RT组差异有统计学意义。亚组分析结果显示,ICU室REBOA组病死率与RT组差异无统计学意义(I^(2)=83%,OR=0.69,95%CI 0.45~1.05,P>0.05),急诊室REBOA组病死率低于RT组(I^(2)=94%,OR=0.52,95%CI 0.38~0.70,P<0.01)。Egger检验显示发表偏倚对结果影响较小。结论与RT治疗相比,REBOA治疗NCTH可降低患者病死率、术后栓塞手术发生率,但是增加了患者的剖腹手术再发生率,同时急诊室比ICU更适合作为REBOA常备的手术区域。Objective To systematically compare the prognosis in non-compressible torso hemorrhage(NCTH)treated by resuscitative endovascular balloon occlusion of the aorta(REBOA)and resuscitation thoracotomy(RT).Methods Data were searched form MEDLINE,EMBASE,PubMed,WanFang,CNKI and VIP databases to collect studies on the prognosis of patients with NCTH undergone REBOA and RT from inception to December 2020.Two reviewers independently screened studies according to the inclusion and exclusion criteria,extracted data and evaluated the quality of the included studies.The Meta-analysis was performed using Revman 5.3.The patients were divided into REBOA group and RT group according to the different surgical treatment methods on admission,and the prognosis of each group was evaluated.The difference of mortality rate,reoperation rate of laparotomy after operation,reoperation rate of embolization after operation and mortality rate in different operating room area were compared between the two groups.Publication bias was assessed using the Egger test.Results A total of 2 prospective studies and 4 retrospective studies involving 2,588 subjects were included.There were 1,591 patients in REBOA group and 997 patients in RT group.Significant differences were observed in the mortality rate(I^(2)=68%,OR=0.33,95%CI 0.26-0.42,P<0.01),reoperation rate of laparotomy after operation(I^(2)=76%,OR=1.41,95%CI 1.11-1.77,P<0.01)and reoperation rate of embolization after operation(I^(2)=84%,OR=0.76,95%CI 0.59-0.99,P<0.05)between REBOA group and RT group.Subgroup analysis showed that the mortality rate in the ICU were not statistically different between the two groups(I^(2)=83%,OR=0.69,95%CI 0.45-1.05,P>0.05),but the mortality rate in the emergency room was lower in REBOA group than that in RT group(I^(2)=94%,OR=0.52,95%CI 0.38-0.70,P<0.01).Egger test showed that publication bias had little effect on the results.Conclusions For patients with NCTH,REBOA can reduce the mortality rate and reoperation rate of embolization after operation,but increase the r

关 键 词：导管插入术 气囊阻塞 胸廓切开术 休克 创伤性 META分析 

分 类 号：R655[医药卫生—外科学]