静脉-动脉体外膜肺氧合联合主动脉内球囊反搏对心源性疾病患者病死率的影响:Meta分析  

Effect of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pumping on mortality in patients with cardiogenic diseases:a meta-analysis

作　　者：陈婧 姚杨[2] 苗继荣 丁格 马青 彭伊梦 卢洲 康凤尔 王胜昱[2] Chen Jing;Yao Yang;Miao Jirong;Ding Ge;Ma Qing;Peng Yimeng;Lu Zhou;Kang Fenger;Wang Shengyu(Department of General Medicine,the First Affiliated Hospital of Xi'an Medical University,Xi'an 710077,China;Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Xi'an Medical University,Xi'an 710077,China)

机构地区：[1]西安医学院第一附属医院全科,西安710077 [2]西安医学院第一附属医院呼吸与危重症医学科,西安710077

出　　处：《中华危重症医学杂志（电子版）》2023年第1期48-59,共12页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：2020年西安市第七批科技计划项目[20YXYJ0001(7)];医学科研发展基金项目临床与基础研究专项(B21021BN);西安医学院呼吸与危重症疾病的基础与转化研究创新团队(2021TD13)。

摘　　要：目的 系统评价静脉-动脉体外膜肺氧合(VA-ECMO)联合主动脉内球囊反搏(IABP)对心源性疾病患者病死率的影响.方法 计算机检索PubMed、The Cochrane Library、Embase、Web of Science、万方、知网和中国生物医学文献数据库自建库至2022年4月发表的关于VA-ECMO联合IABP治疗心源性疾病患者的相关研究.由2名研究员独立筛选文献、提取数据及质量评价后,应用Stata 17软件进行Meta分析.结果 共纳入84篇研究、15 528例患者,其中8 520例患者接受了 VA-ECMO联合IABP治疗(试验组),7 008例患者为单纯VA-ECMO治疗(对照组)oMeta分析显示,试验组患者的入院30d/住院病死率[风险比(RR)=0.86,95%置信区间(CI)(0.83,0.89),Z=8.64,P<0.000 01]及神经系统并发症的发生率[RR=0.70,95%CI(0.54,0.90),Z=2.78,P=0.005]较对照组均显著降低,ECMO 脱机率[RR=1.35,95%CI(1.28,1.42),Z=11.89,P<0.00001]较对照组显著提高.亚组分析显示,与对照组比较,试验组心脏相关混合疾病[RR=0.85,95%CI(0.81,0.90),Z=5.99,P<0.000 01]、急性冠状动脉综合征(ACS)[RR=0.68,95%CI(0.63,0.74),Z=9.21,P<0.000 01]患者的入院 30 d/住院病死率及混合神经系统并发症的发生率[RR=0.58,95%CI(0.40,0.84),Z=2.90,P=0.004]均显著降低,心脏切开术后[RR=1.22,95%CI(1.10,1.34),Z=3.88,P=0.000 1]及心脏相关混合疾病[RR=1.45,95%CI(1.37,1.53),Z=12.51,P<0.00001]患者的ECMO脱机率均显著提高.结论 VA-ECMO联合IABP相较于单独使用VA-ECMO可以降低心脏相关混合疾病及ACS患者的入院30d/住院病死率,增加心脏切开术后及心脏相关混合疾病患者的ECMO脱机率,并可能减少混合神经系统并发症的发生.Objective To systematically evaluate the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pumping (IABP) on the mortality of patients with cardiogenic diseases.MethodsSystematic searches were conducted in PubMed, the Cochrane Library, Embase, Web of Science, Wanfang data, CNKI and CBM to collect articles about using VA-ECMO combined with IABP to treat patients with cardiogenic diseases published up to April 2022. Two reviewers independently screened articles, extracted data and evaluated quality, and then the meta-analysis was performed using Stata 17 software.ResultsA total of 15 528 patients were enrolled in 84 studies, of which 8 520 patients received VA-ECMO combined with IABP (experimental group) and 7 008 patients only received VA-ECMO (control group). Meta-analysis showed that as compared with the control group, the 30-d mortality/inpatient mortality [relative risk (RR) = 0.86, 95% confidence interval (CI) (0.83, 0.89), Z = 8.64, P < 0.000 01] and the incidence of neurological complications [RR = 0.70, 95%CI (0.54, 0.90), Z = 2.78, P = 0.005] decreased remarkably, and the success rate of weaning from ECMO [RR = 1.35, 95%CI (1.28, 1.42), Z = 11.89, P < 0.000 01] increased obviously in the experimental group. Subgroup analysis showed that the 30-d mortality/inpatient mortality in patients with heart-related mixed diseases [RR = 0.85, 95%CI (0.81, 0.90), Z = 5.99, P < 0.000 01] and in patients with acute coronary syndrome (ACS) [RR = 0.68, 95%CI (0.63, 0.74), Z = 9.21, P < 0.000 01] and the incidence of mixed neurological complications [RR = 0.58, 95%CI (0.40, 0.84), Z = 2.90, P = 0.004] were much lower, and the success rate of weaning from ECMO in patients with postcardiotomy [RR = 1.22, 95%CI (1.10, 1.34), Z = 3.88, P = 0.000 1] and heart-related mixed diseases [RR = 1.45, 95%CI (1.37, 1.53), Z = 12.51, P < 0.000 01] were much higher in the experimental group than those in the control group.ConclusionCompared with VA-ECMO alone, VA-ECMO combined with I

关 键 词：体外膜肺氧合 主动脉球囊反搏 病死率 心源性疾病 META分析 

分 类 号：R54[医药卫生—心血管疾病]