肌松剂对急性呼吸窘迫综合征患者氧合影响的Meta分析  

A meta-analysis of the effect of neuromuscular blocking agents on oxygenation in patients with acute respiratory distress syndrome

作　　者：高志伟[1,2] 李聪 陈辉[1] 谢剑锋[1] 刘玲[1] 杨毅[1] Gao Zhiwei;Li Cong;Chen Hui;Xie Jianfeng;Liu Ling;Yang Yi(Department of Critical Care Medicine,Zhongda Hospital,School of Medicine Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine,Nanjing 210009,China;Department of Emergency,the Affiliated Huai′an First People′s Hospital of Nanjing Medical University,Huai′an 223300,China)

机构地区：[1]东南大学附属中大医院重症医学科,江苏省重症医学重点实验室,南京210009 [2]南京医科大学附属淮安第一医院急诊医学科,淮安223300

出　　处：《中华内科杂志》2022年第1期86-94,共9页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金面上项目(81971888,81870066);江苏省社会发展专项(BE2018743);江苏省六大人才高峰项目(TD-SWYY-003,WSW-031)。

摘　　要：目的系统评价肌松剂对急性呼吸窘迫综合征(ARDS)患者氧合的影响。方法联机检索“Medline”“EMBASE”“Web of science”“Cochrane central database”英文数据库及中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库、万方数据库中文数据库。检索2020年5月前发表的肌松剂治疗ARDS的临床随机对照试验(RCT)。按照纳入和排除标准筛选文献,主要分析指标为氧合指数[动脉血氧分压(PaO2)/吸入氧浓度(FiO_(2))]。结果共纳入5项RCT,1462例ARDS患者。与对照组比,干预组使用肌松剂72 h[平均差(MD)为14.39,95%CI 6.40~22.38,P=0.0004]和96 h(MD为15.83,95%CI 7.13~24.52,P=0.0004)氧合指数明显改善,而使用肌松剂48 h 2组氧合指数差异无统计学意义(MD为7.96,95%CI-1.35~17.26,P>0.05)。使用肌松剂72 h和96 h干预组呼气末正压(PEEP)水平明显降低,MD为-0.45(95%CI-0.87~-0.03,P=0.04)和-0.82(95%CI-1.39~-0.26,P=0.004),而使用肌松剂24 h和48 h干预组和对照组PEEP水平差异无统计学意义[MD为-0.37(95%CI-0.75~-0.00,P=0.05)和-0.31(95%CI-0.83~-0.20,P=0.23)]。使用肌松剂96 h干预组平台压明显低于对照组,MD为-1.69(95%CI-2.64~-0.75,P=0.0004),使用肌松剂24 h、48 h和72 h两组平台压差异无统计学意义[MD为0.08(95%CI-0.53~0.70,P=0.79)、0.02(95%CI-0.83~-0.87,P=0.96)、-0.67(95%CI-1.37~0.03,P=0.06)]。结论ARDS患者早期48 h使用肌松剂有延迟改善氧合和降低呼吸条件的效应。Objective To evaluate the effects of neuromuscular blocking agents(NMBA)on oxygenation and respiratory conditions in patients with acute respiratory distress syndrome(ARDS).Methods English databases such as MEDLINE,Embase and Web of Science were searched online,as well as Chinese databases such as China National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database and Wanfang Database.Randomized controlled trials(RCTs)of NMBA therapy for ARDS with publication date up to May 2020 were retrieved.Literature was screened according to inclusion and exclusion criteria,and the main analysis indicators were oxygenation index.Results A total of 5 RCTs were included,and 1462 ARDS patients were enrolled.Compared with the control group,the ratio of partial arterial oxygen pressure to fraction of inspired(PaO2)/(FiO_(2))significantly improved in the intervention group after 72 hours MD=14.39,(95%CI 6.40-22.38,P=0.0004)and 96 hours of NMBA,but there was no difference between PaO2/FiO_(2) at 24 and 48 hours(P>0.05).Positive end expiratory pressure(PEEP)significantly decreased at 72 hours(MD=-0.45,95%CI-0.87--0.03,P=0.04)and 96 hours(MD=-0.82,95%CI-1.39--0.26,P=0.004)treatment with NMBA,while there was no significant difference in PEEP between 24 and 48 hours after treatment(P>0.05).At 96 h,plateau pressure(Pplat)in the intervention group was significantly lower(MD=-1.69,95%CI-2.64--0.75,P=0.0004),and there was no significant difference in Pplat between 24,48 and 72 h after treatment(P>0.05).Conclusion The early use of NMBA within 48 hours has a delayed improvement effect on oxygenation and ventilator conditions in ARDS patients.

关 键 词：呼吸窘迫综合征 成人 肌松剂 氧合指数 呼气末正压 

分 类 号：R563.8[医药卫生—呼吸系统]