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中华卫生应急电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 102 -108. doi: 10.3877/cma.j.issn.2095-9133.2020.02.009

所属专题: 文献

论著

经腹心肺复苏有效性及安全性的meta分析
董婷婷1, 马秀梅2, 林勇3, 涂江义1, 孙国刚1,()   
  1. 1. 646000 四川泸州,西南医科大学人体解剖学教研室
    2. 646000 四川泸州,西南医科大学附属医院内分泌科
    3. 646000 四川泸州,西南医科大学附属中医医院急诊科
  • 收稿日期:2019-03-16 出版日期:2020-04-18
  • 通信作者: 孙国刚
  • 基金资助:
    四川省科技厅-泸州市-泸州医学院联合基金项目(14JC0175); 泸州市人民政府-西南医科大学科技战略合作项目(2015LZCYD-S06); 泸州市科技局项目(泸市科【2010】128号253)

Efficacy and safety of trans-abdominal cardiopulmonary resucitation: a Meta analysis

Tingting Dong1, Xiumei Ma2, Yong Lin3, Jiangyi Tu1, Guogang Sun1,()   

  1. 1. Department of Anatomy, Southwest Medical University, Luzhou 646000, China
    2. Department of Endocrinology, the Affiliated Hospital of Southwest Medical University Luzhou 646000, China
    3. Department of Emergency, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou 646000, China
  • Received:2019-03-16 Published:2020-04-18
  • Corresponding author: Guogang Sun
  • About author:
    Corresponding author: Sun Guogang, Email:
引用本文:

董婷婷, 马秀梅, 林勇, 涂江义, 孙国刚. 经腹心肺复苏有效性及安全性的meta分析[J/OL]. 中华卫生应急电子杂志, 2020, 06(02): 102-108.

Tingting Dong, Xiumei Ma, Yong Lin, Jiangyi Tu, Guogang Sun. Efficacy and safety of trans-abdominal cardiopulmonary resucitation: a Meta analysis[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(02): 102-108.

目的

评价经腹心肺复苏法与标准胸外按压心肺复苏治疗心脏骤停患者有效性和安全性的系统评价,为临床运用腹部心肺复苏提供循证医学依据。

方法

检索万方数据库、中国知网数据库、Sinomed、PubMed、Embase、Medline和Cochrane图书馆数据库,全面检索经腹心肺复苏治疗心脏骤停患者的临床随机对照试验研究,提取数据并使用Stata软件进行meta分析,观察指标主要为经抢救后患者的病死率,患者复苏后的呼气末二氧化碳分压(ETPCO2)、平均动脉压(MAP)及神经功能缺损评分。

结果

共纳入10个临床随机对照试验,累计受试者1 117例。与标准胸外按压心肺复苏相比,经腹部心肺复苏法抢救心脏骤停患者可显著降低患者病死率(RR=0.77,95%CI:0.70~0.84)。其中腹部提压心肺复苏法的RR值为0.69(95%CI:0.61~0.79),插入腹部按压心肺复苏法的RR值为0.84(95%CI:0.75~0.95)。腹部提压心肺复苏法还可增加患者肺潮气量(SMD=14.29,95%CI=10.61~17.97),增加呼气末二氧化碳分压ETPCO2(SMD=5.53,95%CI:3.99~7.06),降低平均动脉压(SMD=-0.56,95%CI:-0.89~-0.24),并且减少了神经功能损害(SMD=-0.57,95%CI:-1.05~-0.09)。

结论

腹部提压心肺复苏法抢救心脏骤停患者的效果佳,可提高临床抢救成功率,腹部提压心肺复苏法可改善患者通气,减少神经功能损害。

Objective

To evaluate the efficacy and safety of cardiopulmonary resuscitation (CPR) in rescuing patients with cardiac arrest, and to provide evidence-based medicine for clinical application of abdominal cardiopulmonary resuscitation.

Methods

The Wanfang database, the Chinese knowledge network database, Sinomed, PubMed, Embase and Medline and Cochrane library were retrieved and the clinical randomized controlled trial for patients with cardiac arrest by CPR was collected; the data were extracted and then the Stata software was used to carry out the meta analysis.

Results

The patients with cardiac arrest by abdominal cardiopulmonary resuscitation could significantly reduce the mortality of patients (RR=0.77, 95%CI=0.70-0.84, I2=75.9%, P<0.001), of which the RR value of abdominal pressure cardiopulmonary resuscitation was 0.69 (95%CI=0.61-0.79), and the RR value inserted into the abdominal compression cardiopulmonary resuscitation was 0.84 (95% CI = 0.75 - 0.95), and the abdomen was raised. CPR could also increase the volume of pulmonary moisture (SMD=14.29, 95%CI=10.61-17.97), PETCO2 (SMD=5.53, 95%CI=3.99-7.06), the end expiratory carbon dioxide (SMD=5.53, 95%CI=3.99-7.06), and reduce the mean arterial pressure (SMD=-0.56, 95%CI=-0.89-0.24) and the damage of nerve function (SMD=-0.57, 95%CI=-1.05-0.09).

Conclusion

Rescue of cardiac arrest patients by central pulmonary resuscitation method can improve the clinical effect, and increase the success rate of rescuing patients. Moreover, the abdominal CPR method can significantly improve the ventilation of patients, promote aerobic metabolism, and reduce neurological impairment with no serious adverse reactions.

图1 文献筛选流程图
表1 纳入文献的基本信息
图3 两组患者血气分析指标及其它次要结局指标的比较
图2 两组患者死亡率比较的meta分析森林图
图4 敏感性分析
图5 文献发表偏倚漏斗图
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