临床应用肺动脉导管对ICU患者死亡率影响的Meta分析

目的 通过Meta分析的方法,评价临床应用肺动脉导管对ICU患者死亡率的影响.方法 计算机检索Ovide MEDLINE、EMBASE、Cochrane Database、中国Cochrane中心临床对照试验资料数据库、中国生物医学文献光盘数据库.手工检索相关杂志、学术会议论文集和学位论文汇编.收集国内外关于临床应用肺动脉导管对成年ICU患者死亡率影响的随机对照试验（RCT）并进行方法学质量评价,用RevMan4.2软件进行Meta分析.结果 最终11篇相关文献入选.8篇属于高质量文献,其他3篇文献均存在不同程度的方法学质量缺陷.根据治疗策略不同将所有入选文献分为超高血流动力学目标治疗组和基于医生经验的个体化治疗组.结果显示,临床应用肺动脉导管不能降低两组患者的死亡率（RR 0,96,95％CI：0.76,1.21；RR 1.02,95％ CI：0.96,1.09）.敏感性分析显示结果稳定.通过漏斗图观察,存在潜在文献发表偏倚的可能性不大.结论 临床应用肺动脉导管并不能改善成年ICU患者的预后,因此肺动脉导管不应该在ICU患者中常规应用.我们期待更多设计良好的RCT进一步评价肺动脉导管在ICU患者治疗中的作用.

Impact of the pulmonary artery catheter on mortality in icu patients:Meta-analysis of randomized controlled trials

Objective To assess the impact of the pulmonary artery catheter （PAC）on mortality in adult ICU patients using a meta-analysis. Methods We searched Ovide MEDLINE, EMBASE, Cochrane Database, and Chinese Cochrane Centre Database and CBMdisc. We manually searched corresponding journals, academic conference proceedings and thesis assembles. We included all kinds of RCTs to estimate the impact of the PAC on mortality in ICU patients, and assessed the methodological quality. RevMan 4. 2 software was used for data analysis. Results There were 11 eligible trials into our meta-analysis. Eight of them were high-quality trials and three were low-quality trials. According to the treatment protocols, we divided all trials into subgroup 1 （supranormal hemodynamic endpoint）and subgroup 2 （designing treatment strategies based on clinicians＇judgement）, and made a sub-category analysis. Overall, our meta-analysis of 11 RCTs evaluating the safety and efficacy of the PAC showed that use of the catheter couldn＇ t decrease mortality of the patients （ RR 0. 96,95 % CI： 0.76,1.21 ; RR 1.02,95 % CI： 0. 96,1.09）. Sensitivity analyses indicated the results were stable. There was little publication bias based on the funnel plots. Conclusions Our meta-analysis did not show any benefits or harms as a result of PAC-led intervention,the result suggested that the PAC should not be routinely used for the management of ICU patients. We are looking forward to more intelligent design RCTs that evaluate the effectiveness of PAC in critically ill patients.