体外膜肺氧合对磷酸铝中毒死亡率的影响：一项系统评价与Meta分析
Effect of extracorporeal membrane oxygenation on mortality rate of aluminum phosphate poisoning: A systematic review and meta-analysis.
作者信息
Moshiri Mohammad, Dorooshi Gholamali, Etemad Leila, Feizi Awat, Rahimi Alireza, Gheshlaghi Farzad, Otroshi Arman, Samsamshariat Shiva, Eizadi-Mood Nastaran
机构信息
Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Res Med Sci. 2024 Oct 24;29:62. doi: 10.4103/jrms.jrms_123_24. eCollection 2024.
BACKGROUND
Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta-analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment.
MATERIALS AND METHODS
Two parallel databases' reviews were done to find the ECMO treatment-applied studies or conventional treatment-applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts were included for ECMO treatment-applied studies. Only English-language human observational studies, which reported MR, were included in conventional treatment-applied studies. All ETAS case reports were summarized and used as a newly generated cross-sectional study (NGCSS) for inclusion in the meta-analysis.
RESULTS
Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross-sectional studies, and 9 conventional treatment-applied studies were selected. In meta-analysis NGCSS applied as the fourth cross-sectional ECMO treatment-applied studies. The overall MR of ECMO-treated cases (23% [95% confidence interval (CI): 7%-39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%-63%]; < 0.001). In ECMO-treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%-6.39%; < 0.0001), exposure to hospitalization lag time (-2.05; 95% CI: -4.05-0.14 h; = 0.06), and length of hospital stay (16; 95% CI: 12.0-20.5 days; < 0.0001) between survived and nonsurvived ETC were significant.
CONCLUSION
ECMO reduced the MR of ALP-poisoned patients; however, it is a highly invasive and complicated procedure.
背景
磷酸铝（ALP）中毒继发心源性休克时死亡率较高。最近，体外膜肺氧合（ECMO）在这一问题上显示出成功的效果。我们进行了一项系统评价和荟萃分析，以比较接受ECMO治疗的ALP中毒患者与接受传统治疗的患者的死亡率。
材料与方法
根据PRISMA方案对两个平行数据库进行检索，以查找应用ECMO治疗的研究或应用传统治疗的研究。应用ECMO治疗的研究纳入所有语言的研究及英文会议摘要。应用传统治疗的研究仅纳入报告了死亡率的英文人体观察性研究。所有ETAS病例报告进行了总结，并用作新生成的横断面研究（NGCSS）纳入荟萃分析。
结果
从167条和1043条记录中，选择了17篇病例报告（24例）、3篇横断面研究和9篇应用传统治疗的研究。在荟萃分析中，NGCSS用作第4篇应用ECMO治疗的横断面研究。接受ECMO治疗病例的总体死亡率（23%[95%置信区间（CI）：7%-39%]）显著低于接受传统治疗的病例（60%[95%CI：39%-63%]；P<0.001）。在接受ECMO治疗的病例中，存活病例与未存活病例在年龄、血液pH值、ALP剂量、住院时间、ECMO延迟时间和ECMO持续时间方面的加权平均差（WMD）无统计学意义。然而，存活与未存活的接受ECMO治疗病例在心排出量分数方面WMD（4.6%；95%CI：2.76%-6.39%；P<0.0001）、住院延迟时间暴露方面（-2.05；95%CI：-4.05-0.14小时；P=0.06）以及住院时间方面（16；95%CI：12.0-20.5天；P<0.0001）具有显著差异。
结论
ECMO降低了ALP中毒患者的死亡率；然而，这是一种具有高度侵入性和复杂性的操作。
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