体外膜肺氧合并发血栓发生率的meta分析  

Meta-analysis of the incidence of extracorporeal membrane oxygenation combined with incident thrombosis

作　　者：彭伊梦 姚杨[1] 李思雨 丁格 孙亚楠 王胜昱[1] Peng Yimeng;Yao Yang;Li Siyu;Ding Ge;Sun Yanan;Wang Shengyu(Department of Pulmonary and Critical 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呼吸与危重症医学科,陕西西安710077

出　　处：《临床荟萃》2024年第1期5-11,共7页Clinical Focus

基　　金：2020年西安市第七批科技计划——BDNT通过下调HDAC促进人体气道平滑肌细胞增生的机制研究[20YXYJ0001(7)];医学科研发展基金项目—临床与基础研究专项——DVC-IWI对COPD患者脱机拔管的预测价值(B21021BN)。

摘　　要：目的 系统评价体外膜肺氧合技术(extracorporeal membrane oxygenation, ECMO)治疗患者血栓发生率。方法 通过“Extracorporeal Membrane Oxygenation或ECMO”、“thrombus或complication”等关键词检索文献,检索PubMed、EMBASE、万方和中国知网数据库建库至2022年12月有关ECMO及血栓并发症的相关研究,指定2人按照纳排标准对检索的文章进行筛选,应用Review Manager 5.4软件进行meta分析及亚组分析,依据纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale, NOS)评价文章质量。结果 经筛选共纳入16篇文献和1 136例患者,Meta分析结果显示ECMO治疗患者血栓的发生率为52.0%(95%CI:0.30~0.88),I2=91%(P<0.01),亚组分析结果显示<45岁、45~59岁ECMO治疗患者并发血栓的发生率分别为27.0%(95%CI:0.14~0.50)、53.0%(95%CI:0.29~0.97),ECMO平均持续时间≤10 d、>10 d血栓发生率分别为50.0%(95%CI:0.34~0.74)、39.0%(95%CI:0.11~1.38),体质量指数为24~27.9 kg/m^(2)、≥28 kg/m^(2)的血栓发生率分别为27.0%(95%CI:0.07~1.07)、66.0%(95%CI:0.36~1.23),活化部分凝血活酶时间(APTT)、激活全血凝固时间(ACT)、抗fxa 3种不同的抗凝监测方式血栓发生率分别为57.0%(95%CI:0.47~0.69)、13.0%(95%CI:0.08~0.20)、45.0%(95%CI:0.36~0.57)。结论 ECMO治疗患者血栓发生率为52.0%,年龄大、ECMO持续时间短、高体质量指数、采用APTT监测抗凝者血栓发生率较高。Objective To systematically evaluate the incidence of thrombotic complications in patients treated with extracorporeal membrane oxygenation technology(ECMO).Methods Articles reporting ECMO and incident thrombosis published before December 2022 were systematically searched in the PubMed,EMBASE,Wanfang and CNKI database using the following keywords:“Extracorporeal Membrane Oxygenation or ECMO”,“thrombus or complication”.Two investigators were responsible for screening eligible articles based on the inclusion and exclusion criteria.Meta-analysis and subgroup analysis were performed using Review Manager 5.4 software.The quality of the included articles was evaluated according to the Newcastle-Ottawa Scale(NOS)scoring system.Results A total of 16 literatures involving 1136 patients were selected.Meta-analysis showed that the incidence of thrombosis in ECMO patients was 52.0%(95%CI:0.30-0.88)and I 2 was 91%(P<0.01).Subgroup analysis showed that the incidence of ECMO concurrent thrombosis in patients<45 years old and 45-59 years old was 27.0%(95%CI:0.14-0.50)and 53.0%(95%CI:0.29-0.97),respectively.The incidence of patients with a mean duration of ECMO≤10 days and>10 days was 50.0%(95%CI:0.34-0.74)and 39.0%(95%CI:0.11-1.38),respectively.The incidence of thrombosis with a body mass index(BMI)of 24-27.9 kg/m^(2) and≥28 kg/m^(2) was 27.0%(95%CI:0.07-1.07)and 66.0%(95%CI:0.36-1.23),respectively.The incidence of thrombosis detected by the anticoagulation monitoring methods of partial thromboplastin time(APTT),activated clotting time(ACT)and anti-factor-Xa(anti-Xa)was 57.0%(95%CI:0.47-0.69),13.0%(95%CI:0.08-0.20)and 45.0%(95%CI:0.36-0.57),respectively.Conclusion The incidence of thrombotic complications in patients treated with ECMO is 52.0%.Patients with an older age,shorter duration of ECMO,greater BMI and monitored for APTT have a higher incidence of thrombotic complications.

关 键 词：体外膜氧合作用 血栓 发生率 

分 类 号：R654.1[医药卫生—外科学]