肥胖降低急性呼吸窘迫综合征的死亡率Meta分析

发布时间：2018-03-15 10:52

本文选题：肥胖　切入点：急性呼吸窘迫综合征　出处：《中国呼吸与危重监护杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的系统评价肥胖对急性呼吸窘迫综合征(acute respiratory aistress syndrome,ARDS)临床预后的影响。方法通过计算机检索Pubmed、EMBASE、Cochrane databases、Wiley、Ovid、Medline、CNKI、VIP、Wanfang数据库中关于肥胖与ARDS及急性肺损伤(acute lung injury,ALI)临床预后的相关文献,运用RevMan5.0及Stata10.0软件进行统计学分析。结果本Meta分析共纳入9篇文献,28368例患者。分析结果显示:肥胖显著降低ARDS的死亡率[OR=0.63,95%可信区间(95%CI)0.41~0.98,P=0.04]。亚组分析结果显示:与正常体重ARDS患者比较,肥胖患者在28d死亡率未见明显差异(OR=0.92,95%CI 0.55~1.54,P=0.76),但是在60d及90d死亡率均明显减低(60d:OR=0.84,95%CI 0.75~0.94,P=0.002;90d:OR=0.38,95%CI 0.22~0.66,P=0.0005)。与正常体重ARDS患者比较,肥胖患者的住院时间及ICU时间延长,机械通气时间缩短,但无统计学意义[住院时间:加权均数差(weighted mean difference,WMD)=3.61,95%CI-0.36~7.57,P=0.07;重症监护病房(intensive care unit,ICU)时间:WMD=1.52,95%CI-0.22~3.26,P=0.09;机械通气时间:WMD=-0.50,95%CI-2.18~1.19,P=0.56]。此外,肥胖患者无需呼吸机辅助呼吸的时间延长(WMD=2.68,95%CI 0.86~4.51,P=0.004)。结论肥胖对ARDS患者的住院时间、ICU时间及机械通气时间无显著影响,但无需呼吸机辅助时间延长,60 d和90 d死亡率显著降低。上述结论需要更多大样本临床随机对照试验加以证实。
[Abstract]:Objective to systematically evaluate the effect of obesity on the clinical prognosis of acute respiratory aistress syndrome (ARDS). Methods the relevant literature on obesity and ARDS and acute lung injury-induced disease (ALI) was searched by computer. RevMan5.0 and Stata10.0 software were used to carry out statistical analysis. Results in this Meta analysis, 28368 patients were included in 9 literatures. The results showed that obesity significantly reduced the death rate of ARDS [OR0.63% 95% CI 0.41 0.98% CI 0.04]. The results of subgroup analysis showed that compared with ARDS patients of normal weight, obesity significantly reduced the mortality of ARDS. There was no significant difference in the mortality of obese patients in 28 days. There was no significant difference in mortality between the two groups. There was no significant difference in the mortality rate between the two groups. However, on the 60d and 90d, the mortality rates of the obese patients were significantly reduced at 60 days: 0. 849 CI 0. 75 and 0. 90D / v.0.3895CI 0.220.66P0.0005. Compared with the patients with normal body weight ARDS, the duration of hospitalization and ICU of obese patients was prolonged, the time of mechanical ventilation was shortened, and the duration of mechanical ventilation was shortened, compared with the patients with normal body weight ARDS, the duration of hospitalization and ICU of obese patients were prolonged, and the duration of mechanical ventilation was shortened. But there was no statistically significant difference in the length of stay [the weighted mean difference was 3.61CI-0.367.57; the intensive care unit was 1.52% CI-0.223.26P0.09; the duration of mechanical ventilation was WMD-0.50CI-2.181.181.19P0.56]. The duration of ventilator free breathing was prolonged in obese patients. Conclusion there was no significant effect of obesity on the duration of hospitalization and mechanical ventilation in ARDS patients. But the mortality rate of 60 days and 90 days without ventilator was significantly reduced. These conclusions need to be confirmed by more large clinical randomized controlled trials.
【作者单位】：济南军区总医院呼吸科;
【分类号】：R563.8;R589.2

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