中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

肥胖降低急性呼吸窘迫综合征的死亡率 Meta 分析

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目的系统评价肥胖对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)临床预后的影响。方法通过计算机检索 Pubmed、EMBASE、Cochrane databases、Wiley、Ovid、Medline、CNKI、VIP、Wanfang 数据库中关于肥胖与 ARDS 及急性肺损伤(acute lung injury,ALI)临床预后的相关文献,运用 RevMan 5.0 及 Stata 10.0 软件进行统计学分析。结果本 Meta 分析共纳入 9 篇文献,28 368 例患者。分析结果显示:肥胖显著降低 ARDS 的死亡率[OR=0.63,95% 可信区间(95%CI)0.41~0.98,P=0.04]。亚组分析结果显示:与正常体重 ARDS 患者比较,肥胖患者在 28 d 死亡率未见明显差异(OR=0.92,95%CI 0.55~1.54,P=0.76),但是在 60 d 及 90 d 死亡率均明显减低(60 d:OR=0.84,95%CI 0.75~0.94,P=0.002;90 d:OR=0.38,95%CI 0.22~0.66,P=0.000 5)。与正常体重 ARDS 患者比较,肥胖患者的住院时间及 ICU 时间延长,机械通气时间缩短,但无统计学意义[住院时间:加权均数差(weighted mean difference,WMD)=3.61,95%CI –0.36~7.57,P=0.07;重症监护病房(intensive care unit,ICU)时间:WMD=1.52,95%CI –0.22~3.26,P=0.09;机械通气时间:WMD=–0.50,95%CI –2.18~1.19,P=0.56]。此外,肥胖患者无需呼吸机辅助呼吸的时间延长(WMD=2.68,95%CI 0.86~4.51,P=0.004)。结论肥胖对 ARDS 患者的住院时间、ICU 时间及机械通气时间无显著影响,但无需呼吸机辅助时间延长,60 d 和 90 d 死亡率显著降低。上述结论需要更多大样本临床随机对照试验加以证实。

ObjectiveTo evaluate systematically the relationship between obesity and clinical prognosis in acute respiratory distress syndrome (ARDS) patients.MethodsA systematic search was performed in Pubmed, EMBASE, Cochrane databases, Wiley, Ovid, Medline, CNKI, VIP and Wanfang. All studies that reported obesity in the clinical prognosis of ARDS and acute lung injury were included. A meta-analysis was performed using RevMan 5.0 and Stata 10.0.ResultsA total of 28 368 patients from 9 studies were included in this meta-analysis. The combined results showed that obesity was associated with the decreased mortality of ARDS [odds ratio(OR)=0.63, 95% confidence intervals (95%CI) 0.41 to 0.98, P=0.04]. In subgroup analysis, the result showed no obvious relationship between obesity and 28-day mortality in ARDS/ALI (OR=0.92, 95%CI 0.55 to 1.54, P=0.76). However, obesity was associated with lower risk of 60days and 90-day mortality in ARDS/ALI (60-day: OR=0.84, 95%CI 0.75 to 0.94, P=0.002; 90-day: OR=0.38, 95%CI 0.22 to 0.66, P=0.000 5). Compared with normal weight patients with ARDS, hospital length of stay, ICU length of stay, and duration of mechanical ventilation did not differ significantly [hospital length of stay: weighted mean difference (WMD)=3.61, 95%CI –0.36 to 7.57, P=0.07; intensive care unit (ICU) length of stay: WMD=1.52, 95%CI –0.22 to 3.26, P=0.09; duration of mechanical ventilation: WMD=–0.50, 95%CI –2.18 to 1.19, P=0.56], but ventilator-free days was significantly longer in obese patients (WMD=2.68, 95%CI 0.86 to 4.51, P=0.004).ConclusionsObesity is not associated with hospital length of stay, ICU length of stay, and duration of mechanical ventilation in patients with ARDS. However, obesity is associated with a reduction of long-term mortality and increased ventilator-free days in the patients with ARDS. Additional larger randomized controlled studies are needed to confirm the possible role of obesity in the clinical prognosis of ARDS.

关键词: 肥胖; 急性呼吸窘迫综合征; 急性肺损伤; Meta 分析

Key words: Obesity; Acute respiratory distress syndrome; Acute lung injury; Meta-analysis

引用本文: 郭治, 邢国宏, 王瑛, 王鑫. 肥胖降低急性呼吸窘迫综合征的死亡率 Meta 分析. 中国呼吸与危重监护杂志, 2017, 16(5): 462-468. doi: 10.7507/1671-6205.201608026 复制

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