1、81实用心脑肺血管病杂志 2023年9月第31卷第9期 投稿网址:http:/医学循证成人心搏骤停患者心肺复苏期间碳酸氢钠应用效果的 Meta 分析谭品义1,孙珺俊1,庞文龙1,韦雪1,李贵源1,莫凡睿2,韦美发1【摘要】目的系统评价成人心搏骤停患者心肺复苏(CPR)期间碳酸氢钠(SB)的应用效果。方法计算机检索PubMed、Cochrane Library、Web of Science、Embase及中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网发表的成人心搏骤停患者CPR期间应用SB效果的随机对照试验(RCT)和回顾性研究,检索时间从建库至2023-03-12。根据患者CP
2、R期间是否采用SB治疗分为SB治疗组与无SB治疗组,应用Stata 16.0软件进行Meta分析,比较SB治疗组与无SB治疗组自发性循环恢复(ROSC)率、出院生存率、持续ROSC(ROSC时间20 min)率及pH值好转率。结果本研究最终纳入11篇文献,其中RCT 5篇、回顾性研究6篇;包括19 173例患者,其中SB治疗组7 782例、无SB治疗组11 391例。Meta分析结果显示,SB治疗组与无SB治疗组ROSC率OR=1.03,95%CI(0.65,1.64)和出院生存率OR=0.48,95%CI(0.14,1.67)比较,差异无统计学意义(P0.05);SB治疗组持续ROSC率低于
3、无SB治疗组OR=0.27,95%CI(0.07,0.98),P0.05,pH值好转率高于无SB治疗组OR=4.56,95%CI(1.88,11.03),P0.05。亚组分析结果显示,在其他国家(除中国外),无SB治疗组ROSC率高于SB组OR=0.51,95%CI(0.43,0.60),P0.05。敏感性分析结果显示,CHUNG等研究的统计学异质性较高。结论SB治疗可以纠正成人心搏骤停患者CPR期间酸中毒情况,但对提高ROSC率、出院生存率无明显益处,甚至不利于持续ROSC。【关键词】猝死,心脏;心搏骤停;心肺复苏术;碳酸氢钠;Meta分析【中图分类号】R 541【文献标识码】ADOI:10
4、.12114/j.issn.1008-5971.2023.00.219Application Effect of Sodium Bicarbonate During CPR in Adults with Sudden Cardiac Arrest:a Meta-analysisTAN Pinyi1,SUN Junjun1,PANG Wenlong1,WEI Xue1,LI Guiyuan2,MO Fanrui2,WEI Meifa11.Department of Cardiology,Liujiang District Peoples Hospital,Liuzhou 545100,China
5、2.Department of Cardiocogy,Liuzhou Workers Hospital,Liuzhou 545027,ChinaCorresponding author:WEI Meifa,E-mail:【Abstract】ObjectiveTo systematically evaluate the application effect of sodium bicarbonate(SB)during cardiopulmonary resuscitation(CPR)in adult patients with sudden cardiac arrest.MethodsPub
6、Med,Cochrane Library,Web of Science,Embase,CNKI,CBM,Wanfang Data,and VIP were searched for randomized controlled trials(RCT)and retrospective studies on the effect of SB during CPR in adult patients with sudden cardiac arrest.The search time was from the establishment of the database to March 12,202
7、3.According to whether SB treatment was used during CPR,the patients were divided into SB treatment group and non-SB treatment group.Meta-analysis was performed using Stata 16.0 software to compare the return of spontaneous circulation(ROSC)rate,survival rate at discharge,continuous ROSC(ROSC time 2
8、0 min)rate and pH improvement rate between SB treatment group and non-SB treatment group.ResultsFinally,11 articles were included in this study,including 5 RCTs and 6 retrospective studies;there were 19 173 patients,including 7 782 cases in the SB treatment group and 11 391 cases in the non-SB treat
9、ment group.The results of Meta-analysis showed that there was no significant difference in ROSC rate OR=1.03,95%CI(0.65,1.64)and survival rate at discharge OR=0.48,95%CI(0.14,1.67)between SB treatment group and non-SB treatment group(P 0.05);the rate of continuous ROSC in SB treatment group was lowe
10、r than that in non-SB treatment group OR=0.27,95%CI(0.07,0.98),P 0.05,and the improvement rate of pH value was higher than that in non-SB treatment group OR=4.56,95%CI(1.88,11.03),P 0.05.Subgroup analysis showed that in other countries(except for China),the ROSC rate in the non-SB treatment group wa
11、s higher than that in the SB treatment group OR=0.51,95%CI(0.43,0.60),P 0.05.The results of sensitivity analysis showed that the statistical heterogeneity of CHUNG et al.was high.ConclusionSB treatment can correct acidosis during CPR in adult patients with sudden cardiac arrest,but it has no signifi
12、cant benefit in improving ROSC rate 基金项目:柳州市科技计划项目(柳科攻2021CBC0124)作者单位:1.545100广西壮族自治区柳州市柳江区人民医院心血管内科2.545027广西壮族自治区柳州市工人医院心血管内科通信作者:韦美发,E-mail:扫描二维码查看更多82Pract J Cardiac Cereb Pneum Vasc DisSeptember 2023,Vol.31No.9http:/通过数据库获得相关文献(n=418):PubMed(n=152)、万方数据知识服务平台(n=62)、中国知网(n=57)、Web of Science(n=
13、53)、Cochrane Library(n=44)、中国生物医学文献数据库(n=37)、维普网(n=10)、Embase(n=3)通过其他途径获得相关文献(n=100)剔除重复文献(n=410)阅读题目和摘要初筛文献(n=108)剔除文献(n=43)剔除文献(n=54):研究对象、内容不符(n=32),综述、会议摘要(n=11),结局指标不相符(n=11)阅读全文复筛文献(n=65)最终纳入Meta分析的文献(n=11)图1文献筛选流程Figure 1Literature screening processand survival rate at discharge,and even is
14、not conducive to continuous ROSC.【Key words】Death,sudden,cardiac;Sudden cardiac arrest;Cardiopulmonary resuscitation;Sodium bicarbonate;Meta-analysis心搏骤停是一种常见的健康问题,全世界每年约有370万人死于心搏骤停1。心肺复苏(cardiopulmonary resuscitation,CPR)是治疗心搏骤停的基本手段,其目的是重启心脏功能,恢复心脏正常的血液循环2。标准的CPR包括基础生命支持和高级心脏生命支持(advanced cardiac
15、 life support,ACLS)。心搏骤停相关指南指出,ACLS包括除颤和药物治疗,其中药物包括肾上腺素、胺碘酮和利多卡 因3-4。研究表明,心搏骤停患者极可能发生严重的代谢性酸中毒5,而理论上碳酸氢钠(sodium bicarbonate,SB)可以将代谢性酸中毒转化为呼吸性酸中毒,然后通过呼吸将二氧化碳排出体外,以提高患者内环境的pH值。因此,相关指南推荐采用SB纠正心搏骤停患者代谢性酸中毒6-7。近年研究表明,早期、频繁使用SB有利于改善心搏骤停患者的短期和长期预后,如患者有较高的自主循环恢复(return of spontaneous circulation,ROSC)率和存活率
16、8-11。但使用SB也存在潜在风险,如导致患者发生高钠血症、碱中毒等,故2010美国心脏协会心肺复苏和心血管急救指南指出心搏骤停期间不能常规使用SB,仅在特殊情况下推荐使用SB(建议级别b级,证据水平C级)12。2020年,BENZ等13研究表明,在美国仍有近2/3的心搏骤停患者被给予SB治疗。但越来越多的研究证实,SB对心搏骤停患者无益14-18,故其治疗效果仍存在争议。基于此,本研究采用Meta分析方法,系统评价了成人心搏骤停患者CPR期间SB的应用效果,以期为成人心搏骤停患者的治疗选择提供参考依据。1资料与方法1.1检索策略计算机检索PubMed、Cochrane Library、Web of Science、Embase及中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网发表的成人心搏骤停患者CPR期间应用SB效果的随机对照试验(randomized controlled trial,RCT)和回顾性研究,检索时间从建库至2023-03-12。此外,检索纳入文献的参考文献。英文检索词:cardiac arrest,CA,heart arrest,cardiac re