【摘要】 目的 综合评价和比较经皮穿刺与手术切开两种置管方式在建立静脉-动脉体外膜肺氧合(V-A ECMO)时的有效性与安全性。方法 检索中国知网(CNKI)、万方数据库及维普网、中国生物医学文献数据库(CBMdisc)、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库和Cochrane临床试验数据库，自建库至2023年1月发表的所有关于比较经皮穿刺置管与手术切开置管对建立V-A ECMO时效果的研究。有效性指标包括：置管成功率、置管时间、成功撤机率、住院病死率；安全性指标包括：下肢缺血发生率、置管部位出血发生率、置管部位感染发生率。对纳入文献进行质量评价后，应用RevMan 5.4软件进行统计学分析，并采用固定效应模型或随机效应模型计算合并后的综合效应，以漏斗图评估发表偏倚。结果 共纳入11篇队列研究，共计患者14 310例；纳入文献质量均较高，纽卡斯尔-渥太华量表(NOS)得分7～8分。Meta分析结果显示，与手术切开置管比较，经皮穿刺置管可降低置管成功率[优势比(OR)=1.41,95%可信区间(95%CI)0.70～2.87,P<0.000 1]、住院病死率(OR=0.81,95%CI 0.75～0.87,P<0.000 01)、置管部位出血发生率(OR=0.41,95%CI 0.22～0.75,P=0.004)、置管部位感染发生率(OR=0.47,95%CI 0.32～0.69,P=0.000 1),但置管时间增加[均数差(MD)=9.48,95%CI 8.22～10.75,P<0.000 01],两组成功撤机率(OR=1.35,95%CI 0.84～2.18,P=0.22)、下肢缺血发生率(OR=0.91,95%CI 0.54～1.56,P=0.75)差异均无统计学意义。结论 在V-A ECMO中，与手术切开置管比较，经皮穿刺置管可降低住院病死率、置管部位出血发生率及置管部位感染发生率，但具有较低的置管成功率及增加置管时间；两种置管方式在成功撤机率及下肢缺血发生率差异无统计学意义。更多还原

【Abstract】 Objective To evaluate and compare the effectiveness and safety of percutaneous cannulation and surgical cannulation in the establishment of venous-arterial extracorporeal membrane oxygenation(V-A ECMO). Methods The research on the comparison between percutaneous and surgical cannulation in V-A ECMO published in CNKI, Wanfang database, VIP, CBMdisc, PubMed, Embase and Cochrane Library from the inception to January 2023 were searched by electronical way. The effective indicators included operation success rate, catheterization time, the rate of successful weaning, hospital mortality.The safety indicators included the rate of lower limb ischemia, the incidence of haemorrhage and infection. After quality evaluation of included studies, the software of RevMan 5.4 was used to analyze those outcomes. The funnel plot was used to evaluate the publication bias. Results Eleven cohort studies with 14 310 patients were included. All of the literatures had high quality, and the Newcastle-Ottawa Scale(NOS) scored 7-8 points.The Meta-analysis showed that compared with the surgical cannulation, percutaneous cannulation could reduce the operation success rate [odds ratio(OR)=1.41,95% confidence interval(95%CI)=0.70-2.87,P<0.000 1], and hospital mortality(OR=0.81,95%CI=0.75-0.87,P<0.000 01), and the incidence of haemorrhage(OR=0.41,95%CI=0.22-0.75,P=0.004),and the incidence of infection(OR=0.47,95%CI=0.32-0.69,P=0.000 1), but increase the operation time[mean difference(MD)=9.48,95%CI=8.22-10.75,P<0.000 01].There was no significant difference in the rate of successful weaning(OR=1.35,95%CI=0.84-2.18,P=0.22),and the rate of lower limb ischemia(OR=0.91,95%CI=0.54-1.56,P=0.75). Conclusions The percutaneous cannulation may reduce the hospital mortality, the incidence of haemorrhage and infection, but has a lower success rate of cannulation and an increase in catheterization time. There was no significant difference in the rate of successful weaning and the rate of lower limb ischemia.更多还原