本文選題：肥胖　切入點(diǎn)：急性呼吸窘迫綜合征　出處：《中國呼吸與危重監(jiān)護(hù)雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的系統(tǒng)評(píng)價(jià)肥胖對(duì)急性呼吸窘迫綜合征(acute respiratory aistress syndrome,ARDS)臨床預(yù)后的影響。方法通過計(jì)算機(jī)檢索Pubmed、EMBASE、Cochrane databases、Wiley、Ovid、Medline、CNKI、VIP、Wanfang數(shù)據(jù)庫中關(guān)于肥胖與ARDS及急性肺損傷(acute lung injury,ALI)臨床預(yù)后的相關(guān)文獻(xiàn),運(yùn)用RevMan5.0及Stata10.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果本Meta分析共納入9篇文獻(xiàn),28368例患者。分析結(jié)果顯示:肥胖顯著降低ARDS的死亡率[OR=0.63,95%可信區(qū)間(95%CI)0.41~0.98,P=0.04]。亞組分析結(jié)果顯示:與正常體重ARDS患者比較,肥胖患者在28d死亡率未見明顯差異(OR=0.92,95%CI 0.55~1.54,P=0.76),但是在60d及90d死亡率均明顯減低(60d:OR=0.84,95%CI 0.75~0.94,P=0.002;90d:OR=0.38,95%CI 0.22~0.66,P=0.0005)。與正常體重ARDS患者比較,肥胖患者的住院時(shí)間及ICU時(shí)間延長,機(jī)械通氣時(shí)間縮短,但無統(tǒng)計(jì)學(xué)意義[住院時(shí)間:加權(quán)均數(shù)差(weighted mean difference,WMD)=3.61,95%CI-0.36~7.57,P=0.07;重癥監(jiān)護(hù)病房(intensive care unit,ICU)時(shí)間:WMD=1.52,95%CI-0.22~3.26,P=0.09;機(jī)械通氣時(shí)間:WMD=-0.50,95%CI-2.18~1.19,P=0.56]。此外,肥胖患者無需呼吸機(jī)輔助呼吸的時(shí)間延長(WMD=2.68,95%CI 0.86~4.51,P=0.004)。結(jié)論肥胖對(duì)ARDS患者的住院時(shí)間、ICU時(shí)間及機(jī)械通氣時(shí)間無顯著影響,但無需呼吸機(jī)輔助時(shí)間延長,60 d和90 d死亡率顯著降低。上述結(jié)論需要更多大樣本臨床隨機(jī)對(duì)照試驗(yàn)加以證實(shí)。
[Abstract]:Objective to systematically evaluate the effect of obesity on the clinical prognosis of acute respiratory aistress syndrome (ARDS). Methods the relevant literature on obesity and ARDS and acute lung injury-induced disease (ALI) was searched by computer. RevMan5.0 and Stata10.0 software were used to carry out statistical analysis. Results in this Meta analysis, 28368 patients were included in 9 literatures. The results showed that obesity significantly reduced the death rate of ARDS [OR0.63% 95% CI 0.41 0.98% CI 0.04]. The results of subgroup analysis showed that compared with ARDS patients of normal weight, obesity significantly reduced the mortality of ARDS. There was no significant difference in the mortality of obese patients in 28 days. There was no significant difference in mortality between the two groups. There was no significant difference in the mortality rate between the two groups. However, on the 60d and 90d, the mortality rates of the obese patients were significantly reduced at 60 days: 0. 849 CI 0. 75 and 0. 90D / v.0.3895CI 0.220.66P0.0005. Compared with the patients with normal body weight ARDS, the duration of hospitalization and ICU of obese patients was prolonged, the time of mechanical ventilation was shortened, and the duration of mechanical ventilation was shortened, compared with the patients with normal body weight ARDS, the duration of hospitalization and ICU of obese patients were prolonged, and the duration of mechanical ventilation was shortened. But there was no statistically significant difference in the length of stay [the weighted mean difference was 3.61CI-0.367.57; the intensive care unit was 1.52% CI-0.223.26P0.09; the duration of mechanical ventilation was WMD-0.50CI-2.181.181.19P0.56]. The duration of ventilator free breathing was prolonged in obese patients. Conclusion there was no significant effect of obesity on the duration of hospitalization and mechanical ventilation in ARDS patients. But the mortality rate of 60 days and 90 days without ventilator was significantly reduced. These conclusions need to be confirmed by more large clinical randomized controlled trials.
【作者單位】： 濟(jì)南軍區(qū)總醫(yī)院呼吸科;
【分類號(hào)】：R563.8;R589.2

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