院外心脏骤停后生存率的性别差异：荟萃分析。
Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis.
机构信息
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
出版信息
Crit Care. 2020 Oct 19;24(1):613. doi: 10.1186/s13054-020-03331-5.
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors.
METHODS
We comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.
RESULTS
The meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89-1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48-0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62-0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47-0.83) compared with males.
CONCLUSIONS
Our results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.
背景
院外心脏骤停（OHCA）是全球范围内导致心源性猝死的主要原因。研究人员发现，女性和男性之间存在显著的病理生理学差异，并且在与医疗服务相关的临床方面存在显著的性别差异。然而，目前的研究结果存在冲突，关于 OHCA 后生存和预后的性别差异尚未达成统一共识。因此，我们研究了 OHCA 的预后与性别因素之间的关系。
方法
我们全面检索了 PubMed、Embase 和 Cochrane 数据库，共获得 1042 篇文章，从中选择了 33 项研究进行纳入。使用随机效应模型估计合并的优势比（OR）和 95%置信区间（CI）。
结果
该 meta 分析共纳入 1268664 例患者。与男性相比，女性年龄更大（69.7 岁比 65.4 岁，p<0.05），且更多的是无目击 OHCA（58.39%比 62.70%，p<0.05）。女性接受院内干预的可能性低于男性。从 OHCA 到入院的生存率方面，女性与男性之间没有显著差异（OR 0.99，95%CI 0.89-1.1）。然而，从入院到出院的生存率（OR 0.59，95%CI 0.48-0.73）、总体到出院的生存率（OR 0.73，95%CI 0.62-0.86）以及良好的神经结局（OR 0.62，95%CI 0.47-0.83），女性的生存机会均低于男性。
结论
我们的研究结果表明，女性的总体出院生存率低于男性，且女性的神经系统预后较差。这可能与女性的病理生理学特征有关，与男性相比，女性的治疗措施更为保守，且复苏后的护理也不同。然而，由于存在多种混杂因素，这些发现应谨慎解释。
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