国际麻醉学与复苏杂志   2017, Issue (2): 0-0
    
远隔缺血预处理对肺损伤患者预后的临床研究Meta分析
郑兰兰, 张贵和, 高昌俊, 孙绪德, 张莲花1()
1.第四军医大学唐都医院麻醉科
The effect of remote ischemic preconditioning on clinical outcomes in patients with lung injury: a Meta-analysis of the randomized controlled trials
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摘要:

目的 系统性评价远隔缺血预处理(remote ischemic preconditioning, RIPC)对各种原因导致的肺损伤的影响。 方法 通过检索PubMed、Embase、Medline、中国知网(CNKI)、维普中文期刊全文数据库、中国生物医学文献数据库、中国生物医学期刊引文数据库,根据纳入标准和排除标准,检索出相关随机对照临床研究文献,并提取主要评估指标(ICU停留时间及机械通气时间)和次要评估指标[术后24 h血清IL-6、TNF-α、IL-8浓度及肺泡动脉氧分压差(alveolar-arterial oxygen tension gradient, A-aDO2)、氧合指数(oxgension index, PaO2/FiO2)、呼吸指数(respiratory index, RI)],采用RevMan5.3和STATA12.0软件进行Meta分析。 结果 共纳入前瞻性随机对照研究8篇,476例患者,其中RIPC组237例,对照组239例。与对照组相比,RIPC可以减少患者术后ICU停留时间及机械通气时间,并降低术后24 h血清TNF-α浓度(P<0.05),其标准均数差(standard mean difference, SMD)和95%CI分别为-0.03(-0.41,-0.05)、-0.2(-0.39,-0.01)、-0.85(-1.35, 0.34)。 结论 RIPC可以减少患者术后ICU停留时间和机械通气时间,改善肺损伤患者的临床预后。

关键词: 远隔缺血预处理; 肺损伤; Meta分析
Abstract:

Objective To systematically evaluate the effect of remote ischemic preconditioning(RIPC) on lung injury induced by many kinds of fators. Methods The literatures were selected according to the inclusive and exclusive criteria from the following databases including PubMed, Embase, Medline, CNKI, VIP Journal Network Publishing Database, Chinese Biomedical Literature Database, Chinese Medical Citation Index. The primary evaluation indicators (postoperative ICU stay time and mechanical ventilation time) and the secondary indicators[serum IL-6, TNF-α, IL-8 levels at 24 h, alveolar-arterial oxygen tension gradient(A-aDO2), PaO2/FiO2, respiratory index(RI) at 24 h after operation] were analyzed. Software RevMan 5.3 and STATA 12.0 were utilized to perform Meta analysis. Results Our search yielded 8 studies including 476 patients. 237 patients of all were allocated into the RIPC group, the others into the control group. Compared with the control group, the ICU stay time and mechanical ventilation time were reduced in RIPC group(P<0.05), and TNF-α level at 24 h after operation was lower in RIPC group (P<0.05). Furtherly, the standard mean difference(SMD) and 95%CI of them were respectively -0.03(-0.41, -0.05), -0.2(-0.39, -0.01), -0.85(-1.35, 0.34). Conclusions Remote ischemic preconditioning could decrease ICU stay time and mechanical ventilation time, improving the clinical outcomes of patients with lung injury.

Key words: Remote ischemic preconditioning; Lung injury; Meta-analysis