Intens Care Med:ARDS 患者肺复张术的意义

2020-02-18 杨中华 脑血管病及重症文献导读

本系统性综述和 meta 分析的目的在于评价 ARDS 患者采用 LRM 对死亡率的作用。

对于 ICU 中急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)患者,在最近的 RCT 研究中未证实肺复张术(Lung recruitment maneuver,LRM)的疗效。本系统性综述和 meta 分析的目的在于评价 ARDS 患者采用 LRM 对死亡率的作用。

在这项系统性综述和 meta 分析中,研究者搜索了成人 ARDS 比较采用 LRM 和未采用 LRM 进行机械通气的 RCT 研究。汇总了相对风险(RR)、平均差异、进行了试验序贯分析和累积 meta 分析。主要终点为28天死亡率。

14项 RCT 试验共3185例患者,与非-LRM 相比,LRM 与28天死亡率下降无关(RR = 0.92, 95% CI 0.82–1.04, P = 0.21)。试验序贯分析显示,已累积了所需的信息量(Trial-sequential-analysis showed that the required information size has been accrued)。LRM 组的PaO2/FiO2 比值显着高于非-LRM 组(mean difference = 47.6 mmHg, 95% CI 33.4–61.8, P < 0.001)。与非-LRM 相比,LRM 与挽救性治疗的下降率有关(RR = 0.69 95% CI 0.56–0.84, P < 0.001),与血流动力学损害的增加率有关(RR = 1.19, 95% CI 1.06–1.33, P = 0.002)。采用累积 meta 分析显示2017年后对死亡率影响的显着变化。

最终作者认为,这个结果提示 ADRS 患者系统性使用 LRM 不能显着降低28天死亡率。不过,LRM 也与一些积极作用有关,比如改善氧合和较少使用挽救性治疗。尽管如此,LRM 与血流动力学受损有关。

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    2020-07-20 drwjr
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