现场第一反应者早期除颤对院外心脏骤停患者存活率影响的Meta分析  

A Meta-analysis of the Effect of Unprofessional Early Defibrillation on the Survival Rate of Patients with Out-ofhospital Cardiac Arrest

作　　者：尹丽达 王佳森 贺永超 李爱群 YIN Lida;WANG Jiasen;HE Yongchao;LI Aiqun(Emergency Department,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China;Operating Room of Middle Area,the Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]滨州医学院烟台附属医院急诊科,山东省烟台市264100 [2]青岛大学附属烟台毓璜顶医院中区病房手术室,山东省烟台市264000

出　　处：《中国全科医学》2022年第14期1757-1764,共8页Chinese General Practice

基　　金：山东省医药卫生科技发展计划项目(202010001191)。

摘　　要：背景现阶段,心血管疾病仍是我国居民死亡的主要病因,每年约有1万人死于院外心脏骤停而院外心脏骤停患者生存率<5%。早期除颤为改善院外心脏骤停患者预后及降低病死率等方面提供了新方法和新途径,但现有研究结论尚存争议,且国内尚无相关系统评价。目的采用Meta分析法,探讨现场第一反应者使用自动体外除颤器(AED)对院外心脏骤停患者存活率的影响。方法计算机检索PubMed、The Cochrane Library、EMBase、CINAHL、中国知网(CNKI)、万方数据知识服务平台、维普网和中国生物医学文献数据库,检索时间为建库至2021年10月。搜集有关现场第一反应者使用AED对患者周存活出院率影响的病例-对照研究或队列研究,采用Cochrane系统评价方法对纳入的病例-对照研究进行质量评价,采用纽卡斯尔-渥太华量表(NOS)对纳入的队列研究进行质量评价;采用Revman 5.4软件进行Meta分析。结果最终纳入12篇文献,共包含22530例患者,文献质量总体在中等以上。Meta分析结果显示,现场第一反应者使用了AED的院外心脏骤停患者周存活率高于现场第一反应者未使用AED的院外心脏骤停者〔OR=0.47,95%CI(0.45,0.50),P<0.001〕;专业现场第一反应者使用AED的院外心脏骤停患者周存活出院率高于非专业现场第一反应者使用AED的院外心脏骤停者〔OR=0.72,95%CI(0.65,0.81),P<0.001〕。结论现场第一反应者早期除颤可提高院外心脏骤停患者周存活出院率,且接受过早期除颤培训的专业急救第一反应者予以早期除颤较非专业急救第一反应者可有效提高院外心脏骤停患者周存活出院率。受纳入研究质量和数量的局限性,上述结论尚需开展更多大样本的前瞻性队列研究验证。Background At this stage,cardiovascular disease is still the main cause of death among residents in China,about 10000 people die from out-of-hospital cardiac arrest every year,and the survival rate of patients with out-ofhospital cardiac arrest is less than 5%.Early defibrillation has provided a new method and approach for improving the prognosis of patients with out-of-hospital cardiac arrest and reducing the mortality rate.However,the existing research conclusions are still controversial,and there is no relevant systematic review in China.Objective Meta-analysis was used to explore the effect of early defibrillation of on-site first responders on the survival rate of out-of-hospital cardiac arrest patients.Methods PubMed,The Cochrane Library,EMBase,CINAHL,CNKI,Wanfang Data and VIP database were retrieved by computer from database establishment to October 2021.A case-control study or cohort study of the impact of AED use on the patient's weekly survival and discharge rate in field first responders was collected,quality evaluation of included case-control studies using the Cochrane Systematic Evaluation Method and quality evaluation of included cohort studies using the New Castle-Ottawa Scale(NOS).Meta-analysis was performed using Revman 5.4 software.Results 12 articles were finally included,covering 22530 patients.The overall quality of the articles was above the medium level.The results of the meta-analysis showed that,the weekly survival and discharge rate of out-of-hospital cardiac arrest patients with early defibrillation by first responders on site was higher than that of out-of-hospital cardiac arrest patients without early defibrillation by first responders on site〔OR=0.47,95%CI(0.45,0.50),P<0.001〕,the weekly survival and discharge rate of out-of-hospital cardiac arrest patients with early defibrillation by professional first responders was higher than that of out-of-hospital cardiac arrest patients with early defibrillation by nonprofessional first responders〔OR=0.72,95%CI(0.65,0.81),P<0.00001〕.C

关 键 词：猝死 心脏 心血管疾病 第一反应者 非专业急救 心脏除颤 存活率 META分析 

分 类 号：R541[医药卫生—心血管疾病]