CAJ | 학술논문

目的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.
목적 계통평개신경기육조체제(NMBA)대급성호흡군박종합정(ARDS)환자예후적영향.방법 통과검색미국국가의학도서관PubMed수거고、Cochrane림상시험수거고、생물의학여약이학문적수거고(EMBASE)、하란《의학문적》、중국생물의학문헌수거고(CBM)화중국기간망전문수거고(CNKI)등문헌수거고,계통수집전세계범위내NMBA치료ARDS환자적수궤대조림상시험(RCT)문헌.안Cochrane계통평개방법사선시험、평개질량、제취자료,채용RevMan 5.0연건진행meta분석.결과 최종납입부합입선표준적문헌3편,공계연구대상431례환자.합병결과현시:여대조조비교,급여NMBA가현저강저ARDS환자28 d병사솔[Peto비치비(OR) =0.57,95％가신구간(95％CI)위0.37 ～ 0.88,P=0.01],유교소적기압상발생솔(OR=0.42,95％ CI위0.20～0.91,P=0.003)；획득성기무력적발생솔여대조조비교상사,무통계학의의(OR=1.20,95％CI위0.67～ 2.14,P=0.54).여대조조비교,재응용NMBA후48 h,총PEEP(OR=0.09,95％CI위-0.50～0.68,P=0.77)、평태압(Pplat,OR=0.62,95％CI위-0.32～1.57,P=0.20)호흡궤상관삼수무명현통계학차이；각시험조간통계학무이질성(P＞0.1,I 2＜50％)；재응용NMBA후120 h,총PEEP교대조조강저(OR=-1.22,95％CI위-2.39-0.04,P=0.04),Pplat여대조조비교유통계학차이(OR=-2.61,95％ CI위-4.50～-0.73,P=0.007).결론 조기응용NMBA치료ARDS환자능강저환자28 d병사솔,개선예후.
Objective To determine the effects of neuromuscular blocking agent (NMBA) on prognosis of patients with acute respiratory distress syndrome (ARDS).Methods PubMed database,the Cochrane Library,EMBASE,Excepta Media,CBM,CNKI and other sources were used for retrieving the pertinent literature.All randomized controlled trials (RCTs) on NMBA treating ARDS patients were enrolled.The Cochrance Collaboration's software RevMan 5.0 was used for data analysis.Two authors independently extracted data and assessed study quality using standardized instruments.Results Three studies were included in the final analysis,providing a sample of 431 patients.The combined results demonstrated a decrease in 28 days mortality [Peto odds ratio (OR) =0.57,95％ confidence interval (95％CI) 0.37-0.88,P=0.01] and lower incidence of barotrauma (OR=0.42,95％ CI 0.20-0.91,P=0.003)after NMBA treatment for patients with ARDS as compared with control group.The incidence of acquired neuromyopathy was similar between NMBA group and control group (OR=1.20,95％CI 0.67-2.14,P=0.54).As compared with the control group at 48 hours,there was no statistical difference in ventilator parameters including total positive end expiratory pressure (PEEP,OR=0.09,95％CI-0.50-0.68,P=0.77) and plateau pressure (Pplat,OR=0.62,95％CI -0.32-1.57,P=0.20).There was no heterogeneity (P＞0.1,I2＜50％).At 120 hours after NMBA treatment,the total PEEP was significantly lower than that of control group (OR =-1.22,95％ CI-2.39 to-0.04,P=0.04),and the difference in Pplat showed statistical difference compared with the control group (OR=-2.61,95％CI-4.50 to-0.73,P=0.007).Conclusion Early administration of NMBA for ARDS patients results in a significant reduction in 28 days mortality,and it improves outcome.