体外心肺复苏患者继发神经系统并发症风险预测模型的系统评价  

Systematic review of risk prediction models for secondary neurological complications in patients undergoing extracorporeal cardiopulmonary resuscitation

作　　者：唐林霞 周春清 林伊慧 裘云霞 马小琴[1] Tang Linxia;Zhou Chunqing;Lin Yihui;Qiu Yunxia;Ma Xiaoqin(School of Nursing,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学护理学院,浙江杭州310053

出　　处：《护理学杂志》2025年第5期42-47,共6页Journal of Nursing Science

摘　　要：目的系统评价体外心肺复苏患者住院期间继发神经系统并发症风险预测模型,为临床实践提供依据。方法计算机检索中国知网、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Web of Science、Embase、CINAHL、Cochrane Library中有关体外心肺复苏患者继发神经系统并发症风险预测模型的研究,检索时限从建库至2024年4月。由2名研究者独立筛选文献、评价文献质量、提取数据。结果共纳入17项研究,涉及18个模型。受试者工作特征曲线下面积为0.700~0.945;模型重复报告前5位的预测因子为年龄、ECMO前乳酸水平、可电击心律、CPR到ECMO治疗的时间、ECMO前的pH值;乳酸水平的测量时间尚存在争议;纳入17项研究均为高偏倚风险,主要原因是数据来源不合适、变量事件数<20、缺乏模型性能评估以及模型过度拟合等;14项研究总体适应性较好。结论针对体外心肺复苏患者住院期间继发神经系统并发症的风险预测模型尚不完善。在后续的研究与模型开发中,应尽可能避免偏倚,同时重点关注模型的实用性和可操作性,以便为临床决策提供科学依据,从而优化患者的治疗计划和改善预后。Objective To systematically evaluate the risk prediction models for secondary neurological complications in patients undergoing extracorporeal cardiopulmonary resuscitation(ECPR)during hospitalization,and to provide a basis for clinical practice.Methods A comprehensive search was conducted in databases including CNKI,Wanfang Data,CBM,PubMed,Web of Science,Embase,CINAHL,and Cochrane Library for studies on risk prediction models for secondary neurological complications in ECPR patients,covering the period from database inception to April 8,2024.Two researchers independently screened the literature,assessed the quality of the studies,and extracted data.Results A total of 17 studies were included,involving 18 models with area under the receiver operating characteristic curve(AUC)ranging from 0.700 to 0.945.The top five repeatedly reported predictive factors of the models were age,pre-ECMO lactate level,shockable rhythm,time from CPR to ECMO initiation,and pre-ECMO pH value.There was ongoing debate regarding the time of lactate level measurement.All 17 included studies were deemed to have a high risk of bias,primarily due to inappropriate data sources,events per variable being less than 20,lack of model performance evaluation,and overfitting of models and so on;the overall applicability of the 14 studies were relatively good.Conclusion The risk prediction models for secondary neurological complications in ECPR patients during hospitalization are still imperfect.Future research and model development should strive to minimize bias and focus on the practicality and operability of models to provide scientific evidence for clinical decision-making,thereby optimizing patient treatment plans and improving prognosis.

关 键 词：体外心肺复苏 神经系统并发症 预测模型 系统评价 循证护理 

分 类 号：R473.73[医药卫生—护理学]