Wang Ai-tian, Gao Jing-li, Li Xiao-lan, Leng Yu-xin, Yao Zhi-yuan, Zhu Xi
Department of Intensive Care Unit, Coal General Hospital, Hebei, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Mar;25(3):149-53. doi: 10.3760/cma.j.issn.2095-4352.2013.03.008.
To determine the effects of neuromuscular blocking agent (NMBA) on prognosis of patients with acute respiratory distress syndrome (ARDS).
PubMed database, the Cochrane Library, EMBASE, Excepta Media, CBM, CNKI and other sources were used for retrieving the pertinent literature. All randomized controlled trials (RCTs) on NMBA treating ARDS patients were enrolled. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. Two authors independently extracted data and assessed study quality using standardized instruments.
Three studies were included in the final analysis, providing a sample of 431 patients. The combined results demonstrated a decrease in 28 days mortality [Peto odds ratio (OR) =0.57, 95% confidence interval (95%CI) 0.37-0.88, P=0.01] and lower incidence of barotrauma (OR=0.42, 95%CI 0.20-0.91,P=0.003) after NMBA treatment for patients with ARDS as compared with control group. The incidence of acquired neuromyopathy was similar between NMBA group and control group (OR=1.20, 95%CI 0.67-2.14, P=0.54). As compared with the control group at 48 hours, there was no statistical difference in ventilator parameters including total positive end expiratory pressure (PEEP, OR=0.09, 95%CI -0.50-0.68, P=0.77) and plateau pressure (Pplat, OR=0.62, 95%CI -0.32-1.57, P=0.20). There was no heterogeneity (P>0.1, I (2)<50%). At 120 hours after NMBA treatment, the total PEEP was significantly lower than that of control group (OR=-1.22, 95%CI -2.39 to -0.04, P=0.04), and the difference in Pplat showed statistical difference compared with the control group (OR=-2.61, 95%CI -4.50 to -0.73, P=0.007).
Early administration of NMBA for ARDS patients results in a significant reduction in 28 days mortality, and it improves outcome.
确定神经肌肉阻滞剂（NMBA）对急性呼吸窘迫综合征（ARDS）患者预后的影响。
通过PubMed数据库、Cochrane图书馆、EMBASE、Excerpta Medica、中国生物医学文献数据库（CBM）、中国知网（CNKI）等检索相关文献。纳入所有关于NMBA治疗ARDS患者的随机对照试验（RCT）。采用Cochrance协作网的RevMan 5.0软件进行数据分析。两位作者独立提取数据，并使用标准化工具评估研究质量。
最终分析纳入三项研究，共431例患者。合并结果显示，与对照组相比，ARDS患者接受NMBA治疗后28天死亡率降低[Peto比值比（OR）=0.57，95%置信区间（95%CI）0.37 - 0.88，P = 0.01]，气压伤发生率降低（OR = 0.42，95%CI 0.20 - 0.91，P = 0.003）。NMBA组与对照组获得性神经肌肉病变的发生率相似（OR = 1.20，95%CI 0.67 - 2.14，P = 0.54）。与对照组在48小时时相比，包括呼气末正压（PEEP，OR = 0.09，95%CI - 0.50 - 0.68，P = 0.77）和平台压（Pplat，OR = 0.62，95%CI - 0.32 - 1.57，P = 0.20）在内的通气参数无统计学差异。不存在异质性（P > 0.1，I²<50%）。在NMBA治疗120小时后，总PEEP显著低于对照组（OR = - 1.22，95%CI - 2.39至 - 0.04，P = 0.04），Pplat与对照组相比差异有统计学意义（OR = - 2.61，95%CI - 4.50至 - 0.73，P = 0.007）。
ARDS患者早期使用NMBA可显著降低28天死亡率，并改善预后。
