Wang Chih-Hung, Chang Wei-Tien, Huang Chien-Hua, Tsai Min-Shan, Yu Ping-Hsun, Wang An-Yi, Chen Nai-Chuan, Chen Wen-Jone
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Resuscitation. 2014 Sep;85(9):1142-8. doi: 10.1016/j.resuscitation.2014.05.021. Epub 2014 Jun 2.
Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients.
We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded.
Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2>300 mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95% CI, 1.02-1.93; I2, 69.27%; 8 studies) but not worsened neurological outcome (OR, 1.62; 95% CI, 0.87-3.02; I2, 55.61%; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses.
Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously.
研究表明，心脏骤停后自主循环恢复（ROSC）的动物中，高氧存在有害影响。为了使现有临床研究的价值最大化，我们对人类观察性研究进行了系统评价和荟萃分析，以检验高氧对ROSC后患者预后的影响。
我们检索了从数据库建立至2013年10月的PubMed和Embase。我们选择了成年观察性研究，这些研究比较了ROSC后患者不同水平的动脉血氧分压（PaO2）与出院时死亡率或神经功能状态作为结局。仅比较低氧与正常氧的研究被排除。
从2982篇参考文献中识别出14项研究。采用比值比（OR）作为效应估计值。如果原始文章未提供，则重新构建OR。高氧定义为PaO2>300 mmHg。荟萃分析表明，高氧似乎与住院死亡率增加相关（OR，1.40；95%CI，1.02 - 1.93；I2，69.27%；8项研究），但与神经功能结局恶化无关（OR，1.62；95%CI，0.87 - 3.02；I2，55.61%；2项研究）。然而，亚组分析和敏感性分析结果不一致。
高氧似乎与ROSC后患者住院死亡率增加相关。由于显著的异质性和所分析研究数量有限，该结果应谨慎解读。然而，由于暴露于高氧无明显益处，临床医生应密切监测PaO2并谨慎调整氧疗。
