低压复苏治疗创伤失血性休克的系统评价

目的 系统评价低压复苏治疗创伤失血性休克的有效性.方法 计算机检索Pubmed、Embase和The Corchrane Library等数据库,纳入低压复苏治疗创伤失血性休克的随机对照试验或半随机对照试验,检索时间均为从建库至2015年8月.由2位研究者独立进行资料提取和质量评价,采用RevMan 5.3软件进行Meta分析,计数资料使用相对危险度(risk ratio,RR)及其95％可信区间(confidence interval,CI)进行评估,并采用GRADE 3.6.1软件对证据质量进行分级.结果 纳入4项研究,Meta分析及GRADE评级结果显示:与常规复苏比较,低压复苏有较低的总病死率[RR =0.77,95％ CI:0.62～0.95,P=0.01;n=984,GRADE评级:中]及24 h病死率[RR=0.47,95％CI:0.24～0.91,P=0.03;n=281,GRADE评级:中];但总病死率的亚组分析结果显示:在钝挫伤或穿透伤亚组以及穿透伤亚组,两组差异无统计学意义.结论 低压复苏能够降低创伤失血性休克患者的总病死率及24h病死率,证据质量为中级.未来研究应该着力于低压复苏对于不同创伤类型患者的疗效进行进一步探索.     

体外心肺复苏应用于心脏骤停患者神经功能预后的系统评价和Meta分析

目的 通过系统评价探讨体外膜肺氧合(ECMO)辅助下心肺复苏(CPR)对心脏骤停(CA)患者神经功能预后的影响。方法 检索从建库至2023年2月PubMed、Web of Science、Ovid、Cochrane Library、中国知网、万方数据库、中华医学期刊全文数据库、中国生物医学文献数据库等。根据文献纳入和排除标准进行文献筛选、质量评价和资料提取,应用RevMan 5.3软件进行统计分析。结果 共纳入9项研究,共计2 694例患者,其中体外心肺复苏(ECPR)组717例患者,传统心肺复苏(CCPR)组1 977例。Meta分析结果显示,与CCPR相比,ECPR可以提高CA患者短期(出院或1个月内)神经功能预后[OR=2.93,95%CI(1.76,4.87),P<0.000 1]及长期神经功能预后[OR=0.12,95%CI(0.07,0.17),P<0.000 01]。亚组分析表明,在院内心脏骤停(IHCA)和院外心脏骤停(OHCA)患者中实施ECPR对改善出院时的神经功能预后方面异质性较大(组内I²≥50%,P<0.05),而在改善...     

重度颅脑创伤病人损伤控制复苏护理方案的构建

目的:构建重度颅脑创伤病人损伤控制复苏护理方案。方法:组建研究团队,通过回顾文献、相关问题讨论,拟定临床护理方案的初稿,采用德尔菲法进行两轮专家函询,征询专家意见,最终确定重度颅脑创伤病人损伤控制复苏的护理方案。结果:两轮专家函询问卷的有效回收率分别为93.33%、100.00%,专家权威系数为0.83,0.87,专家意见的肯德尔和谐系数为0.35,0.39,最终形成的护理方案包括2个一级条目,15个二级条目,46个三级条目。结论:构建的重度颅脑创伤病人损伤控制复苏护理方案科学、可靠、适用,可为临床护理工作提供参考。     

芦荟治疗急慢性创伤疗效的系统评价

目的系统评价芦荟及芦荟产品（如外用敷料及凝胶等）对急性创伤（如撕裂伤、手术切口及烧伤等）和慢性创伤（如感染性伤口及动静脉溃疡等）的疗效。方法计算机检索TheCochraneLibrary、PubMed、EMbase、CBM、CNKI和VIP,检索时限均为从建库至2012年4月,收集芦荟或其派生产品治疗急慢性创伤的随机对照试验（RCT）。由2名研究者独立进行文献筛选、数据提取及偏倚风险评估后,采用RevMan5．0软件进行Meta分析。结果最终纳入15个RCT,共计773例患者,纳入研究的质量均较低。8个RCT评价芦荟用于治疗急性创伤（烧伤、痔切除术及皮肤活检）,所有文献均未涉及是否有感染发生这一指标。Meta分析结果显示：与磺胺嘧啶银乳膏相比,芦荟产品能提高烧伤患者的伤口愈合数[RR=I．28,95％CI（1．03,1．60）,P=0．03];与抗生素霜相比,芦荟产品能缩短烧伤患者的平均伤口愈合时间[MD=-12．90,95％CI（-13．29,-12．51）,P〈0．00001）];与传统治疗相比,芦荟凝胶增加了皮肤急性外科创伤伤口愈合患者数[RR=16．33,95％CI（3．46,77．15）,P=0．0004],能提高压疮患者伤口愈合数[RR=1．73,95％CI（1．21,2．49）,P=0．003]。结论应用芦荟外用制剂或敷料对急慢性创伤均有积极意义,但此结论至今仍缺少高质量研究证据予以支持。     

损伤控制复苏在急诊的运用

<正>随着现代社会发展和科学的进步,创伤已然成为一个公共卫生保健问题,因道路交通事故造成的严重创伤愈加增多。根据2017年国家安全生产监督管理总局国际交流合作中心等发布的道路交通运输安全发展报告,2015年我国道路交通事故起数为187781起,万车死亡率为2.08%,连续十年高居世界主要部分国家第一~([1])。国外有学者~([2])统计56%～87%的创伤患者由于大出血没能获得及时有效救治而死于院前,其中80%～90%因出血致死的创伤患者院前如果能     

严重腹部创伤患者损伤控制复苏护理方案的构建

目的基于损伤控制复苏理念,构建严重腹部创伤患者损伤控制复苏护理方案。方法通过文献回顾、临床观察及头脑风暴等方法,整合腹部创伤相关指南和文献,制订护理方案初稿,经德尔菲法专家函询,确定严重腹部创伤患者损伤控制复苏护理方案。结果2轮专家函询中,专家积极系数分别为88.89%、100%,专家权威系数均为0.88,2轮函询条目的肯德尔和谐系数分别为0.29、0.32,最终形成的护理方案包括2项一级条目,15项二级条目,50项三级条目。结论本研究构建的护理方案具有科学性、可靠性及适用性,可为临床创伤护理提供指导。     

腹部提压心肺复苏有效性与安全性的系统评价与Meta分析

目的:系统评价腹部提压心肺复苏与标准胸外按压心肺复苏治疗心跳呼吸骤停的有效性与安全性。方法:计算机检索MEDLINE、EMBASE、The Cochrane Library、Web of Science、CNKI、WanFang Data和CBM数据库,检索时限均从建库至2018年4月15日,同时补充检索clnicaltrials.gov registry、百度学术引擎等查找相关文献,手工检索所有纳入文献的参考文献。根据Cochrane系统评价方法,筛选关于腹部提压心肺复苏对比标准胸外按压心肺复苏治疗心跳呼吸骤停患者的中、英文随机对照试验(RCT),进行纳入文献的资料提取和质量评价,采用RevMan5.3软件进行Meta分析,对比试验组与对照组的自主循环恢复率(ROSC)、出院生存率、长短期生存率以及并发症发生率等指标。结果:仅有4篇随机对照研究符合纳入标准,偏倚风险评价显示研究质量不高,Meta分析结果显示,腹部提压心肺复苏组的ROSC率高于标准胸外按压心肺复苏组,差异有统计学意义(RR=1.46,95%CI:1.10～1.94,P=0.010);腹部提压心肺复苏组患者的短期生存率(小于2周)高于标准心肺复苏组,且差异具有统计学意义(RR=4.73,95%CI:1.98～11.29,P=0.0005)。与标准胸外按压心肺复苏组相比,腹部提压心肺复苏组胸肋骨骨折的发生率更小(RR=0.08,95%CI:0.01～0.61,P=0.01)。无研究报告患者的出院生存率、长期生存率及腹部脏器损伤等并发症的发生率。结论:腹部提压心肺复苏可能是一种可供选择的有效复苏方法,但仍需进一步开展基础和临床研究。     

术中获得性压力性损伤危险因素的系统评价和meta分析

目的 通过系统评价明确术中获得性压力性损伤(intraoperative acquired pressure injury,IAPI)发生的危险因素,为预防IAPI提供依据.方法 计算机检索PubMed、Web of Science、Cochrane library、OVID、EMBASE、中国生物医学文献数据库(CB...     

运用反馈装置辅助实施心肺复苏的Meta分析

目的:系统评价反馈装置对心肺复苏实施效果的影响。方法:计算机检索Cochrane图书馆(2017年第12期)、MEDLINE、EMBASE、中国生物医学文献数据库(CBM)、中国知网(CNKI)数据库和万方数据库(检索时限均从建库至2017年12月)中关于运用反馈装置辅助实施心肺复苏的随机对照试验。由2名研究员分别筛选文献、提取资料和进行质量评价后,使用RevMan 5.3软件进行Meta分析。结果:纳入9项随机对照试验进行定量综合,包括934例参与者,其中实验组541例,对照组393例。Meta分析结果显示,运用反馈装置辅助实施心肺复苏能够改善按压深度[MD=0.27,95%CI(0.12,0.42),P=0.0004]("2010年及以后"亚组)和按压频率[MD=-5.44,95%CI(-7.38,-3.50),P<0.001],提高按压位置准确率[MD=6.37,95%CI(1.54,11.21),P=0.01]。结论:运用反馈装置辅助实施CPR有助于提高心肺复苏质量,建议推广使用。     

山莨菪碱对脑复苏神经功能影响的系统评价

目的 系统评价山莨菪碱对脑复苏神经功能影响的临床疗效及安全性.方法 搜索中国期刊全文数据库CNKI(1979年1月至2011年1月)、Pubmed(1978年1月至2011年1月)、The Cochrane Library,搜集山莨菪碱对脑复苏神经功能影响的随机对照试验,按照Cochrane协作网等的相关方法评价纳入文献质量和提取有效数据进行Meta分析.结果 共纳入4项研究,包括327例患者.Meta分析结果显示,心肺脑复苏应用山莨菪碱可提高患者早期格拉斯哥昏迷评分(GCS) [MD=1.4,95％CI (0.98,1.82),P＜0.01]及降低中期神经功能缺陷评分(NFI) [MD=-4.38,95％ CI(-5.26,-3.51),P＜0.01];此外,2项研究提示可降低远期神经功能缺损程度;2项研究提示对于2～3个月患者的生活能力有较大提高;1项研究提示对生活质量(QL)提高有较好作用;1项研究提示其可抑制兴奋性氨基酸释放.所纳入全部研究没有严重不良反映报道.结论 山莨菪碱在心肺脑复苏的应用可以促进神经功能恢复,对脑复苏有益且相对安全.     

Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials

Introduction

The evidence for adrenaline in out-of-hospital cardiac arrest (OHCA) resuscitation is inconclusive. We systematically reviewed the efficacy of adrenaline for adult OHCA.

Methods

We searched in MEDLINE, EMBASE, and Cochrane Library from inception to July 2013 for randomized controlled trials (RCTs) evaluating standard dose adrenaline (SDA) to placebo, high dose adrenaline (HDA), or vasopressin (alone or combination) in adult OHCA patients. Meta-analyses were performed using random effects modeling. Subgroup analyses were performed stratified by cardiac rhythm and by number of drug doses. The primary outcome was survival to discharge and the secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, and neurological outcome.

Results

Fourteen RCTs (n = 12,246) met inclusion criteria: one compared SDA to placebo (n = 534), six compared SDA to HDA (n = 6174), six compared SDA to an adrenaline/vasopressin combination (n = 5202), and one compared SDA to vasopressin alone (n = 336). There was no survival to discharge or neurological outcome differences in any comparison group, including subgroup analyses. SDA showed improved ROSC (RR 2.80, 95%CI 1.78–4.41, p < 0.001) and survival to admission (RR 1.95, 95%CI 1.34–2.84, p < 0.001) compared to placebo. SDA showed decreased ROSC (RR 0.85, 95%CI 0.75–0.97, p = 0.02; I² = 48%) and survival to admission (RR 0.87, 95%CI 0.76–1.00, p = 0.049; I² = 34%) compared to HDA. There were no differences in outcomes between SDA and vasopressin alone or in combination with adrenaline.

Conclusions

There was no benefit of adrenaline in survival to discharge or neurological outcomes. There were improved rates of survival to admission and ROSC with SDA over placebo and HDA over SDA.     

Effect of institutional volume on laparoscopic cholecystectomy outcomes: Systematic review and meta-analysis

AIM: To determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury (BDI). METHODS: Eligible studies were prospective or retrospective cohort studies that provided data on outcomes from consecutive LC procedures in single institutions. Relevant outcomes were mortality, conversion to open surgery, bile leakage and BDI. We performed a Medline search and extracted data. A regression analysis using generalized estimating equations were used to determine the influence of annual institutional LC caseload on outcomes. A sensitivity analysis was performed including only those studies that were published after 1995. RESULTS: Seventy-three cohorts (127404 LC procedures) were included. Average complication rates were 0.06% for mortality, 3.23% for conversion, 0.44% for bile leakage and 0.28% for bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Results from the sensitivity analyses were similar. CONCLUSION: Institutional volume is a determinant of LC complications. It is unclear whether volume is directly linked to complication rates or whether it is an index for protocolised care.     

电针治疗脑卒中后痉挛性瘫痪系统评价

目的:系统评价电针治疗脑卒中后痉挛性瘫痪的临床疗效。方法:检索中国期刊全文数据库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(重庆维普)、中国生物医学文献服务系统SinoMed、PubMed、Cochrane Library、Web of Science数据库建库至2020年3月关于电针治疗脑卒中后痉挛性瘫痪的中、英文文献。2名研究员对检出文献进行整理,依据Cochrane协作网偏倚风险评价工具进行偏倚风险评估,选用RevMan5.3软件进行Meta分析。结果:最终纳入11篇文献,共879例患者。Meta分析结果提示,有效率评定电针组疗效优于对照组RR=1.27,95%CI[1.16,1.40];改良的Ashworth量表(MAS)评定电针组疗效优于对照组MD=-0.36,95%CI[-0.57,-0.16];简式Fugl-Meyer评分法(FMA)评定电针组疗效优于对照组MD=10.55,95%CI[8.76,12.34];改良Barthel指数(MBI)评定电针组疗效优于对照组MD=6.85,95%CI[5.16,8.53];神经功能缺损程度评分(NDS)评定电针组疗效优于对照组MD=-2.61,95%CI[-3.01,-2.20];临床痉挛指数(CSI)评定电针组优于对照组MD=-1.11,95%CI[-1.60,-0.62],差异均具有统计学意义。结论:电针对于脑卒中后痉挛性瘫痪有一定疗效,鉴于纳入的文献数量较少、质量较低,仍需更多高质量的研究,为临床循证提供依据。     

Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis

INTRODUCTION: Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking. OBJECTIVE: To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation. METHOD: A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge. RESULTS: Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%. CONCLUSIONS: Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.     

Clinical benefits of corticosteroid administration during adult cardiopulmonary resuscitation: A systemic review and meta-analysis

BACKGROUNDThe clinical benefits of steroid administration during cardiac arrest remain unclear. Several studies reported that patients who received steroids after achieving a return of spontaneous circulation (ROSC) had better outcomes, but few studies have investigated the benefits of steroid administration during resuscitation. We hypothesized that administration of steroid during cardiac arrest would be associated with better clinical outcomes in adults with cardiac arrest.AIMTo investigate the effect of steroid administration during cardiac arrest and the outcomes of resuscitation.METHODSWe included studies of participants older than 18 years of age who experienced cardiac arrest and included at least one arm that received corticosteroids during cardiac arrest. A literature search of PubMed and Embase on 31 January 2021 retrieved placebo-controlled studies without limitation for type, location, and initial presenting rhythm of cardiac arrest. The study outcomes were reported by odds ratios (ORs) compared with placebo. The primary outcome was survival rate at hospital discharge. Secondary outcomes included a sustained ROSC, survival rate at hospital admission, and neurological outcome at hospital discharge.RESULTSSix studies including 146262 participants were selected for analysis. The risk of bias ranged from low to high for randomized-controlled trials (RCTs) and low (for non-RCTs). Steroid administration was associated with increased survival at hospital discharge [OR: 3.51, 95% confidence interval (CI): 1.98-6.20, P < 0.001], and steroid administration during cardiac arrest was associated with both an increased rate of sustained ROSC (OR: 1.81, 95%CI: 1.91-4.02, P < 0.001) and a favorable neurological outcome at hospital discharge (OR: 3.02, 95%CI: 1.26-7.24, P = 0.01).CONCLUSIONSteroid administration during cardiac arrest was associated with better outcomes of resuscitation. Further study of the use of steroid in the selected circumstances are warranted.     

Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation

Study aim

Adherence to Advanced Trauma Life Support (ATLS) protocol has been associated with improved management of injured patients. The objective of this study is to determine factors associated with delayed and omitted ATLS primary and secondary survey tasks at a level 1 pediatric trauma center.

Methods

Video recorded resuscitations of 237 injured patients < 18 years old obtained over a four month period at our hospital were evaluated to assess completeness and timeliness of essential tasks in the primary and secondary survey of ATLS. Multivariate analyses were performed to identify features associated with decreased ATLS performance.

Results

Primary survey findings were stated less often in patients with burn injuries compared to those with blunt injuries (RR = 1.72; 95% CI: 1.26–2.35) and less often during the overnight shift [11 PM–7 AM] (RR = 1.22; 95% CI: 1.02–1.46). Secondary survey findings were verbalized less often in patients with penetrating injures (RR = 2.30; 95% CI: 1.06–5.00). Time to statement of primary surveys findings was delayed in patients with burn injuries (HR = 0.69; 95% CI: 0.48–0.98) and among those transferred from another hospital. Completeness and timeliness of ATLS task performance were not associated with age or injury severity score.

Conclusions

Mechanism of injury and hospital factors are associated with incomplete and delayed primary and secondary surveys. Interventions that address deficient ATLS adherence related to these factors may lead to a reduction in errors during this critical period of patient care.     

The top determinants and magnitude of preterm neonatal mortality in Ethiopia. Systematic review and meta-analysis

BackgroundThroughout the World, preterm mortality is a major public health problem and a tragic event. Especially for a baby's family. However, it can sometimes be prevented with the proper treatment of neonatal problems.ObjectiveOur Meta-analysis was intended to measure country-level prevalence and the top factors associated with preterm newborn mortality in Ethiopia.MethodsPopular databases such as Science Direct, Hinari, Google Scholar, Embase, the Cochrane Library, and PubMed were thoroughly searched. Two Studies delineating the prevalence of preterm mortality and associated factors were included to determine the pooled prevalence. A standardized data extraction tool prepared in Microsoft Excel was used for data extraction, and the STATA 14 statistical software package was used for analysis. The Cochrane Q test statistics and the I² test were used to assess non-uniformity. In this meta-analysis fixed-effect model and random-effect model were used to estimate the pooled magnitude and associated factors of preterm neonatal deaths respectively.ResultThe cumulative analysis of 17 studies reported that the pooled prevalence of preterm neonatal death was determined to be 12.97% (95% CI, 6.83–24.6) in the Democratic Republic of Ethiopia. Among those studies, the top magnitude was 24.70% which was conducted in Bahirdar town Amhara Regional state of Ethiopia. Preterm mortality was considerably associated with neonatal sepsis [OR = 2.28, 95% CI: (1.24, 4.20)], respiratory distress syndrome [OR = 3.24, 95% CI: 2.35, 4.46], and perinatal asphyxia [OR = 3.27, 95% CI: 1.38, 7.74] with their respective odds ratios and confidence levels. However, utilization of Kangaroo mother care can prevent 76% of preterm neonatal mortality as identified in this meta-analysis.ConclusionIn Ethiopia, preterm neonatal mortality was relatively high when compared to other countries. Neonatal sepsis and respiratory distress syndromes were found to be significantly associated with preterm neonatal mortality; however, Kangaroo Mother Care utilization was associated with a significant reduction in preterm neonatal deaths.The Ethiopian Ministry of Health needs to give attention to improving the quality of the preterm neonatal health care system and encourage the implementation of kangaroo mother care and community-based health care system strategies.