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不同气道管理方法对院外心搏骤停患者复苏效果影响的Meta分析

Effects of different airway management methods on resuscitation of out-of-hospital cardiac arrest patients: a Meta-analysis

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【作者】 姜晓娟王芙蓉李培武

【Author】 JIANG Xiaojuan;WANG Furong;LI Peiwu;First-aid Center of Lanzhou University Second Hospital;

【通讯作者】 李培武;

【机构】 兰州大学第二医院急救中心

【摘要】 目的 使用荟萃分析对气管内插管(ETI)和声门上气道(SGA)两种气道管理方法在院外心搏骤停患者心肺复苏中的应用效果进行分析,对比二者之间的应用效果差异,为院外心搏骤停的急救提供参考。方法 对多个医学数据库内气道管理在院外心搏骤停患者中的应用效果研究相关文献进行检索和收集,日期为数据库建库至2023年6月。按照研究目标和需求进行文献筛选和纳入。对纳入的文献进行质量评价、风险质量评估和结局指标对比研究。本次研究的结局指标主要是心搏骤停患者自主循环恢复(ROSC)率、入院时存活率、出院时存活率、出院后神经功能完整性;次要观察指标为ETI/SGA相关并发症。对纳入文献进行敏感性和异质性分析,探究纳入文献的偏倚性。结果 本次研究共纳入文献16篇,文献中除1项为随机对照实验外均为队列研究。两组患者的基本信息相似,均衡可比。研究结果显示院外心搏骤停患者接受ETI可明显提高自主循环恢复率,入院存活率,且患者出院后神经功能完整性更好(P<0.05),但出院后存活率两种气道管理方式无明显差异(P>0.05)。气道管理的并发症相对较少,研究显示气道管理方式与并发症发生率无明显影响(P>0.05)。结论对比两种气道管理方式,ETI在维护患者自主循环、入院存活率及出院后神经功能方面表现更好,其他方面无明显差异,提示在院外心搏骤停患者的治疗中可以有限选择ETI气道管理方式,以更好地降低心搏骤停患者的病死率和致残率。

【Abstract】 Objective To use a meta-analysis to analyze the application effects of two airway management methods,endotracheal intubation(ETI) and supraglottic airway(SGA) in cardiopulmonary resuscitation of patients with cardiac arrest outside the hospital, and compare the differences in application effects between the two methods, providing reference for emergency treatment of cardiac arrest outside the hospital.Methods Literatures on the application effect of airway management in patients with out-of-hospital cardiac arrest were searched and collected from multiple medical databases. The date was from the establishment of the database to June 2023. The literature was screened and included according to the research objectives and needs. The quality evaluation, risk quality assessment and comparative study of outcome indicators of the included literature were conducted. The main outcome indicators of this study were the return of spontaneous circulation(ROSC) rate, survival rate at admission, survival rate at discharge, and neurological integrity after discharge. The secondary outcome was ETI/SGA related complications. The sensitivity and heterogeneity of the included literature were analyzed to explore the bias of the included literature.Results A total of 16 articles were included in this study, and all of them were cohort studies except one randomized controlled trial. The basic information of the two groups of patients was similar and balanced. The results showed that patients with out-of-hospital cardiac arrest receiving ETI could significantly improve the recovery rate of spontaneous circulation and the survival rate of admission, and the neurological integrity of patients after discharge was better( P<0.05). However, there was no significant difference in the survival rate after discharge between the two airway management methods(P>0.05). The complications of airway management are relatively rare, and studies have shown that there is no significant change in airway management methods and complication rates(P>0.05).Conclusion ETI performs better in maintaining spontaneous circulation, survival rate on admission, and neurological function after discharge than the other airway management methods. The results of this study suggest that ETI airway management can be limited in the treatment of patients with out-of-hospital cardiac arrest, which can better reduce the mortality and disability rate of patients with cardiac arrest.

【基金】 甘肃省自然科学基金(编号:22JR11RA054)
  • 【文献出处】 中国急救复苏与灾害医学杂志 ,China Journal of Emergency Resuscitation and Disaster Medicine , 编辑部邮箱 ,2024年05期
  • 【分类号】R459.7
  • 【下载频次】46
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