垂体后叶素联合肾上腺素应用于心肺复苏治疗效果的meta分析

doi:10.3969/j.issn.1004-583X.2024.03.002

摘要/Abstract

摘要：

目的系统评价垂体后叶素联合肾上腺素应用于心肺复苏治疗的效果。方法计算机检索PubMed、The Cochrane Library、VIP、CNKI、WanFang Date数据库(建库至2022年10月),按照纳入与排除标准选择文献、评价质量并提取资料后,采用RevMan 5.3软件进行meta分析。结果共纳入符合条件的17篇文献,共计1059例患者。Meta分析结果显示:垂体后叶素联合肾上腺素增加自主循环恢复率[RR=2.02, 95%CI(1.74, 2.34),P<0.01],缩短自主循环恢复时间[MD=-8.91, 95%CI(-11.13, -6.69),P<0.01],增加了24 h存活率[RR=2.43, 95%CI(1.86, 3.18),P<0.01]及出院存活率[RR=2.41, 95%CI(1.83, 3.18),P<0.01],降低了终止复苏率[RR=0.39, 95%CI(0.22, 0.68),P=0.001],增加了复苏后6 h尿量[MD=130, 95%CI(113.68, 146.32),P<0.01];但复苏后平均动脉压及心电图ST-T下移两组间差异无统计学意义。结论垂体后叶素联合肾上腺素应用于心肺复苏治疗时,可明显提高复苏成功率,缩短复苏时间,提高患者24 h及出院存活率,增加复苏后6 h尿量,改善器官灌注。

关键词: 心肺复苏术, 垂体后叶素, 肾上腺素, Meta分析

Abstract:

Objective To systematically evaluate the effects of pituitrin combined with epinephrine in treating cardiopulmonary resuscitation (CPR). Methods We retrieved the literatures about pituitrin combined with epinephrine in treating CPR published in PubMed, The Cochrane Library, VIP, China National Knowledge Infrastructure (CNKI) and WanFang Date from inception to October 2022. Literature selection, quality evaluation and data extraction were performed according to inclusion and exclusion criteria, and a meta-analysis was completed by RevMan 5.3. Results Seventeen eligible literatures representing 1059 patients were included. The results of meta-analysis showed that pituitrin combined with epinephrine significantly increased the rate of return of spontaneous circulation (ROSC) (RR=2.02, 95%CI[1.74, 2.34], P<0.01), shorten the time to ROSC (MD=-8.91, 95%CI[-11.13, -6.69], P<0.01), and significantly increased the 24 h survival rate (RR=2.43, 95%CI[1.86, 3.18], P<0.01) and discharge survival rate (RR=2.41, 95%CI[1.83, 3.18], P<0.01), significantly reduced termination-of-resuscitation rate (RR=0.39, 95%CI[0.22, 0.68], P=0.001), significantly increased urine volume at 6 hours after resuscitation (MD=130, 95%CI[113.68, 146.32], P<0.01). However, after resuscitation, there was no significant difference in mean arterial pressure and ST-segment depression on electrocardiography between groups. Conclusion Pituitrin combined with epinephrine on CPR can significantly improve the success rate of resuscitation, shorten the time to resuscitation, improve 24 h and discharge survival rate, increase urine volume at 6 hours after resuscitation, and improve organ perfusion.

Key words: cardiopulmonary resuscitation, pituitrin, epinephrine, Meta-analysis

中图分类号:

R654.1

李冠珠, 杨亚婷, 邓金和, 邵兰, 曾朝坤. 垂体后叶素联合肾上腺素应用于心肺复苏治疗效果的meta分析[J]. 临床荟萃, 2024, 39(3): 208-215.

Li Guanzhu, Yang Yating, Deng Jinhe, Shao Lan, Zeng Chaokun. Effects of pituitrin combined with epinephrine in cardiopulmonary resuscitation: A meta-analysis[J]. Clinical Focus, 2024, 39(3): 208-215.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.03.002

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I3/208

图/表 12

参考文献 38

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纳入研究	样本量 (P/E)	年龄(岁) (P/E)	患者类型	干预措施(P/E)	结局指标
张楠2020^[8]	23/23	65.7±5.6 65.4±5.3	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	④
刘喆2016 ^[9]	36/36	56.1±2.3 55.7±2.1	心肺复苏患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑥⑦⑧
刘喆2015^[10]	19/19	31.32±2.71	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③
邵宝德2015^[11]	50/50	48.7±13.4 50.2±10.3	呼吸心跳骤停患	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
刘建凌2014^[12]	25/25	64.27±5.36 64.65±5.39	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
吕鋆2013^[13]	22/18	60.2±19.4	心跳骤停患者	垂体后叶素24 U+肾上腺素1 mg/肾上腺素1 mg	①④
梁振佳2013^[14]	31/29	56±17	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②⑤
钟敏华2013^[15]	31/30	60.2±19.6	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑤
蒋勇2012^[16]	26/19	52.3±4.5	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑥⑦⑧
浦清2012^[17]	45/45	50.5	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③⑥
张丽2011^[18]	30/29	61.4±21.5	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
黄兆章2010^[19]	26/23	58.7±19.6	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①④
胡运杰2010^[20]	52/51	63.1	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①④⑤
刘坤2009^[21]	32/30	/	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
张红2009^[22]	26/30	64	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③
莫文庆2008^[23]	30/28	62.4±21.8	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
毕晓峰2005^[24]	37/31	62.4±20.2	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②

纳入研究	样本量 (P/E)	年龄(岁) (P/E)	患者类型	干预措施(P/E)	结局指标
张楠2020^[8]	23/23	65.7±5.6 65.4±5.3	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	④
刘喆2016 ^[9]	36/36	56.1±2.3 55.7±2.1	心肺复苏患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑥⑦⑧
刘喆2015^[10]	19/19	31.32±2.71	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③
邵宝德2015^[11]	50/50	48.7±13.4 50.2±10.3	呼吸心跳骤停患	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
刘建凌2014^[12]	25/25	64.27±5.36 64.65±5.39	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
吕鋆2013^[13]	22/18	60.2±19.4	心跳骤停患者	垂体后叶素24 U+肾上腺素1 mg/肾上腺素1 mg	①④
梁振佳2013^[14]	31/29	56±17	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②⑤
钟敏华2013^[15]	31/30	60.2±19.6	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑤
蒋勇2012^[16]	26/19	52.3±4.5	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④⑥⑦⑧
浦清2012^[17]	45/45	50.5	呼吸心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③⑥
张丽2011^[18]	30/29	61.4±21.5	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
黄兆章2010^[19]	26/23	58.7±19.6	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①④
胡运杰2010^[20]	52/51	63.1	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①④⑤
刘坤2009^[21]	32/30	/	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
张红2009^[22]	26/30	64	心跳骤停患者	垂体后叶素40 U+肾上腺素1 mg/肾上腺素1 mg	①②③
莫文庆2008^[23]	30/28	62.4±21.8	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②③④
毕晓峰2005^[24]	37/31	62.4±20.2	心跳骤停患者	垂体后叶素20 U+肾上腺素1 mg/肾上腺素1 mg	①②