俯卧位通气对静脉-静脉体外膜肺氧合支持的急性呼吸窘迫综合征患者病死率影响的Meta分析

目的系统评价俯卧位通气对静脉-静脉体外膜肺氧合（VV-ECMO）支持的急性呼吸窘迫综合征（ARDS）患者病死率的影响。 方法计算机检索Medline、荷兰医学文摘Embase、Cochrane临床试验数据库、万方数据库及中国知网数据库从2002年1月至2022年1月关于VV-ECMO支持ARDS期间使用俯卧位通气的随机对照研究或观察性研究。试验组为俯卧位通气患者，对照组为仰卧位通气患者。由2名研究人员独立进行筛选文献、提取文献资料及评估方法学质量后，采用RevMan 5.3软件进行Meta分析。 结果最终纳入14项研究，共计1 880例患者，其中试验组869例，对照组1 011例。Meta分析显示，与对照组比较，试验组VV-ECMO支持的ARDS患者的28 d病死率相对危险度（RR）=0.59，95%置信区间（CI）（0.43，0.80），Z = 3.41，P = 0.000 7]及住院病死率RR = 0.73，95%CI（0.66，0.81），Z = 5.86，P < 0.000 01]均显著降低；但两组患者间其他病死率（30 d、60 d、90 d、ICU、6个月病死率）的比较，差异无统计学意义RR = 0.80，95%CI（0.61，1.05），Z = 1.60，P = 0.11]。 结论俯卧位通气能够降低VV-ECMO支持的ARDS患者28 d病死率以及住院病死率。

Effect of prone position ventilation on mortality in patients with acute respiratory distress syndrome supported by veno-venous extracorporeal membrane oxygenation: a meta-analysis

ObjectiveTo systematically evaluate the effect of prone position ventilation on mortality in patients with acute respiratory distress syndrome (ARDS) supported by veno-venous extracorporeal membrane oxygenation (VV-ECMO). MethodsRandomized controlled studies or observational studies concerning prone position ventilation for ARDS patients supported by VV-ECMO published from January 2002 to January 2022 in Medline, Embase, Cochrane Library, Wangfang and CNKI databases were searched comprehensively and systematically. Two reviewers independently screened articles, extracted data and evaluated methodological quality. Then meta-analysis was performed using the RevMan 5.3. ResultsA total of 14 articles with 1 880 patients were enrolled in this study, 869 patients in the experimental group (prone position ventilation) and 1 011 patients in the control group (supine position ventilation). Meta-analysis showed that the 28-day mortality relative risk (RR) = 0.59, 95% confidence interval (CI) (0.43, 0.80), Z = 3.41, P = 0.000 7] and in-hospital mortality RR = 0.73, 95%CI (0.66, 0.81), Z = 5.86,P < 0.000 01] in the experimental group were much lower than those in the control group. However, the other mortality (30-day, 60-day, 90-day, ICU and 6-month mortality) was not significantly different between the two groups RR = 0.80, 95%CI (0.61, 1.05), Z = 1.60, P = 0.11]. ConclusionProne position ventilation can reduce the 28-day mortality and in-hospital mortality in ARDS patients supported by VV-ECMO.