目标体温管理对体外心肺复苏患者神经功能结局和出院生存率影响的系统评价  

Effect of targeted temperature management on neurological outcome and survival rate in the patients with extracorporeal cardiopulmonary resuscitation

作　　者：王海珍[1,2] 程鹏飞 郭璐瑶 王美玲[1] 许赫 顾培培 吴金晶 杨旻斐[1,2] Wang Haizhen;Cheng Pengfei;Guo Luyao;Wang Meiling;Xu He;Gu Peipei;Wu Jinjing;Yang Minfei(Department of Nursing,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院护理部,浙江杭州310009 [2]浙江大学医学院附属第二医院急诊医学科,浙江杭州310052

出　　处：《中国急救医学》2024年第2期133-141,共9页Chinese Journal of Critical Care Medicine

基　　金：国家中医药管理局科技司-浙江省中医药管理局共建重大项目(GZY-ZJ-KJ-24030);浙江大学医学院附属第二医院护理部2022年科研项目(2022-02)。

摘　　要：目的系统评价目标体温管理对体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者神经功能结局和出院生存率的影响。方法计算机检索PubMed、Cochrane Library、Elsevier、Web of Science、Ovid、中国知网、万方、SinoMed、中华医学期刊全文数据库中关于目标体温管理对ECPR患者结局指标影响的文献,检索时限均从建库至2023年6月1日。严格按照纳入排除标准进行筛选,提取资料,评价文献质量,采用RevMan 5.3软件对纳入研究进行Meta分析。结果共纳入8篇研究,包括3687例ECPR患者。与非目标体温管理组比较,目标体温管理未能显著改善患者神经功能结局(OR=1.37,95%CI 0.89~2.13,P=0.16)和出院生存率(OR=0.98,95%CI 0.82~1.15,P=0.77),且两组出血、下肢缺血、肾损伤和感染等ECMO相关并发症发生率差异无统计学意义(OR=1.24,95%CI 0.91~1.68,P=0.17)。结论目标体温管理对ECPR患者的神经结局和出院生存率无显著改善作用,但不会加重ECMO相关并发症的发生。Objective To evaluate the effect of targeted temperature management(TTM)on neurological outcome and survival rate in the patients with extracorporeal cardiopulmonary resuscitation(ECPR).Methods We searched the literatures of PubMed,Cochrane Library,Elsevier,Web of Science,Ovid,CNKI,Wanfang,SinoMed,and China Medical Journal Full-text Database about the effect of TTM on the outcomes of patients with ECPR.The search time limit was from the establishment of the database to June 1,2023.In strict accordance with the inclusion and exclusion criteria,the data were extracted,and the quality of the literatures was evaluated.RevMan 5.3 software was used for Meta analysis of the included studies.Results A total of 8 studies involving 3687 patients were included.Compared with the non-TTM group,TTM did not significantly improve the survival rate at discharge(OR=0.98,95%CI 0.82-1.15,P=0.77)and neurological outcome(OR=1.37,95%CI 0.89-2.13,P=0.16).There was no significant difference in the incidence of extracorporeal membrane oxygenation(ECMO)-related complications including bleeding,lower limb ischemia,renal injury and infection between the two groups(OR=1.24,95%CI 0.91-1.68,P=0.17).Conclusions TTM does not significantly improve the neurological outcome and survival rate of patients with ECPR,but does not aggravate the incidence of ECMO-related complications.

关 键 词：体外心肺复苏(ECPR) 心脏骤停 目标体温管理 生存率 神经功能 体外膜氧合(ECMO) Meta分析 

分 类 号：R473[医药卫生—护理学]