神经肌肉阻滞剂对急性呼吸窘迫综合征患者预后影响的荟萃分析

王爱田，高景利，李晓岚，冷玉鑫，姚智渊，朱曦.神经肌肉阻滞剂对急性呼吸窘迫综合征患者预后影响的荟萃分析[J].中华危重病急救医学,2013,25(3),149-

急性呼吸窘迫综合征，随机对照临床试验，神经肌肉阻滞剂，系统评价

王爱田，高景利，李晓岚，冷玉鑫，姚智渊，朱曦

河北唐山，开滦总医院ICU，北京大学第份医院ICL

2013年

149-153

知网

系统评价神经肌肉阻滞剂(NMBA)对急性呼吸窘迫综合征(ARDS)患者预后的影响.方法 通过检索美国国家医学图书馆PubMed数据库、Cochrane临床试验数据库、生物医学与药理学文摘数据库(EMBASE)、荷兰《医学文摘》、中国 生物医学文献数据库(CBM)和中国期刊网全文数据库(CNKI)等文献数据库,系统收集全世界范围内NMBA治疗ARDS患者的随机对照临床试验 (RCT)文献.按Cochrane系统评价方法筛选试验、评价质量、提取资料,采用RevMan 5.0软件进行meta分析.结果 最终纳入符合入选标准的文献3篇,共计研究对象431例患者.合并结果显示:与对照组比较,给予NMBA可显著降低ARDS患者28 d病死率[Peto比值比(OR) =0.57,95％可信区间(95％CI)为0.37 ～ 0.88,P=0.01],有较少的气压伤发生率(OR=0.42,95％ CI为0.20～0.91,P=0.003)；获得性肌无力的发生率与对照组比较相似,无统计学意义(OR=1.20,95％CI为0.67～ 2.14,P=0.54).与对照组比较,在应用NMBA后48 h,总PEEP(OR=0.09,95％CI为-0.50～0.68,P=0.77)、平台压(Pplat,OR=0.62,95％CI为 -0.32～1.57,P=0.20)呼吸机相关参数无明显统计学差异；各试验组间统计学无异质性(P＞0.1,I 2＜50％)；在应用NMBA后120 h,总PEEP较对照组降低(OR=-1.22,95％CI为-2.39-0.04,P=0.04),Pplat与对照组比较有统计学差异 (OR=-2.61,95％ CI为-4.50～-0.73,P=0.007).结论 早期应用NMBA治疗ARDS患者能降低患者28 d病死率,改善预后. To determine the respiratory distress s}"ndrome effects of neuromuscular blocking agent(NMBA) on prognosis of (ARDS) EMBASE, Excepta Media, CBM, CNKI and other sources mere controlled trials ( RCTs)on NMBA treating ARDS patients Methods PubMed database, the Cochrane Lihrarv. used for retrieving the pertinent literature. All randomized were enrolled. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. Two authors independently extracted data standardized instruments. Results The combined results demonstrated and assessed study quality using Three studies were included in the final analysis, providing a sample of 431 patients a decrease in 28 clays mortality (Peto odds ratio interval (95%CI) 0.37-0.88, P=0.01〕and lower incidence of barotrauma(OR =0.42 after NMBA treatment for patients with ARDS as compared with control (OR)=0.57, 95% confidence ，950lo CI 0.20-0.91, P=0.003) was similar between NMBA control group at 48 hours expiratory pressure ( PEEP, group and control group(OR =1.20 group. The incidence of acquired neuromyopathy95%CI0.67-2.14, P=0.54). As compared with the there was no statistical difference in ventilator parameters including total positive end 0.62 -0.32-1.57, P=0.20).OR=0.09, 95%CI -0.50-0.68，P=0.77) and plateau pressure (Pplat, OR There was no heterogeneity (P}0.1，IZ。