Wei Xue-Biao, Wang Zhong-Hua, Liao Xiao-Long, Guo Wei-Xin, Qin Tie-He, Wang Shou-Hong
Department of Gerontological Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Pharmacol. 2020 Jan 29;10:1637. doi: 10.3389/fphar.2019.01637. eCollection 2019.
The therapeutic role of neuromuscular blocking agents (NMBA) in patients with acute respiratory distress syndrome (ARDS) remains controversial.
We systematically reviewed randomized controlled trials investigating the use of NMBA in ARDS patients from inception to July 2019. Relative risk (RR) was calculated for the incidence of barotrauma and mortality using the random-effect or fixed-effect model according to heterogeneity analysis.
Data were combined from five randomized controlled trials that included 1,461 patients (724 in the NMBA group and 737 in the control group). Pooled analysis showed that NMBA infusion did not reduce 28-day mortality (RR = 0.72, 95% confidence interval (CI) 0.44 to 1.17, =0.180, I-squared = 62.8%), but was associated with lower intensive care unit (ICU) mortality (RR = 0.60, 95% CI 0.41 to 0.88, = 0.009, I-squared = 9.2%). In addition, the incidence of barotrauma was significantly lower in patients treated with NMBA (RR = 0.53, 95% CI 0.33 to 0.84, = 0.007, I-squared = 0). However, infusion of NMBA might increase the risk of ICU-acquired weakness (RR = 1.34, 95% CI 0.97 to 1.84, = 0.066, I-squared = 0).
Infusion of NMBA could reduce ICU mortality and the incidence of barotrauma. The risk of ICU-acquired weakness was higher in moderate-to-severe ARDS patients treated with NMBA. The real effects of NMBA need to be further evaluated and confirmed by a study with a stricter design.
神经肌肉阻滞剂（NMBA）在急性呼吸窘迫综合征（ARDS）患者中的治疗作用仍存在争议。
我们系统回顾了从开始到2019年7月调查NMBA在ARDS患者中使用情况的随机对照试验。根据异质性分析，使用随机效应或固定效应模型计算气压伤发生率和死亡率的相对风险（RR）。
数据来自五项随机对照试验，共纳入1461例患者（NMBA组724例，对照组737例）。汇总分析显示，输注NMBA并未降低28天死亡率（RR = 0.72，95%置信区间（CI）0.44至1.17，P = 0.180，I² = 62.8%），但与较低的重症监护病房（ICU）死亡率相关（RR = 0.60，95%CI 0.41至0.88，P = 0.009，I² = 9.2%）。此外，接受NMBA治疗的患者气压伤发生率显著较低（RR = 0.53，95%CI 0.33至0.84，P = 0.007，I² = 0）。然而，输注NMBA可能会增加ICU获得性肌无力的风险（RR = 1.34，95%CI 0.97至1.84，P = 0.066，I² = 0）。
输注NMBA可降低ICU死亡率和气胸发生率。接受NMBA治疗的中重度ARDS患者发生ICU获得性肌无力的风险更高。NMBA的实际效果需要通过设计更严格的研究进一步评估和确认。
