摘要
目的探讨性别差异与院外心脏骤停(OHCA)患者预后之间的关联。方法检索与收集中英文数据库中关于性别与OHCA患者预后相关的研究,进行偏移风险评估后通过RevMan 5.3软件对OHCA患者的自主呼吸循环恢复(ROSC)、入院生存率、出院生存率、神经功能预后等数据进行分析。结果共纳入12篇队列研究,涉及449128例患者,其中女性组173747例,男性组275381例。研究结果显示,男性ROSC(OR=1.05,95%CI 1.07~1.15,Z=5.68,P<0.00001)、出院生存率(OR=1.46,95%CI 1.48~1.93,Z=7.68,P<0.00001)、神经功能预后(OR=1.40,95%CI 1.37~1.44,Z=25.02,P<0.00001)均优于女性,女性在入院存活率方面优于男性(OR=0.95,95%CI 0.94~0.97,Z=5.88,P<0.00001)。亚组Meta分析结果显示,复苏后进行目标体温管理(TTM)[OR=1.33(1.21~1.46),P<0.00001;OR=1.40(1.18~1.66),P<0.0001]、进行经皮冠状动脉介入治疗(PCI)[OR=1.44(1.25~1.65),P<0.00001;OR=3.06(2.39~3.93),P<0.00001]、进行冠状动脉血管造影(CAG)[OR=2.32(1.75~3.07),P<0.00001;OR=1.58(1.14~2.21),P=0.007]的OHCA患者出院生存率均增加。亚组分析结果显示,复苏后进行TTM、PCI、CAG对结果有明显影响。敏感性分析显示,结果稳健性相对良好。结论OHCA后男性的生存获益显著,并且女性面临不良神经功能预后。
Objective To investigate the correlation between gender differences and outcomes in the patients with out-of-hospital cardiac arrest(OHCA).Methods To retrieve and collect the researches on the gender and prognosis of OHCA patients in Chinese and English databases,and to evaluate the return of spontaneous circulation(ROSC),admission survival rate,discharge survival rate,neurological prognosis and other data of OHCA patients by RevMan 5.3 software after bias risk assessment.Results A total of 12 cohort studies were included,involving 449128 patients,173747 patients in the female group and 275381 patients in the male group.The results showed that males were significantly better at ROSC(OR=1.05,95%CI 1.07-1.15,Z=5.68,P<0.00001),and discharge survival rate(OR=1.46,95%CI 1.48-1.93,Z=7.68,P<0.00001),neurological prognosis(OR=1.40,95%CI 1.37-1.44,Z=25.02,P<0.00001)than females,and women were better than men in terms of admission survival rate(OR=0.95,95%CI 0.94-0.97,Z=5.88,P<0.00001).The results of subgroup Meta analysis showed that discharge survival rate of OHCA patients with targeted temperature management(TTM)after resuscitation[OR=1.33(1.21-1.46),P<0.00001;OR=1.40(1.18-1.66),P<0.0001],percutaneous coronary intervention(PCI)[OR=1.44(1.25-1.65),P<0.00001;OR=3.06(2.39-3.93),P<0.00001],coronary angiography(CAG)[OR=2.32(1.75-3.07),P<0.00001;OR=1.58(1.14-2.21),P=0.007]was increased.The results of subgroup analysis showed that TTM,PCI,and CAG after resuscitation had significant effects on the results.Sensitivity analysis showed that the robustness of the results were relatively good.Conclusions The results of this Meta analysis show that men have a significant survival benefit after OHCA,and women face poor neurological prognosis.
作者
陈丽花
骆丁
程鹏飞
张娜
周明
张华
Chen Li-hua;Luo Ding;Cheng Peng-fei;Zhang Na;Zhou Ming;Zhang Hua(School of International Nursing,Hainan Medical University,Haikou 571199,China)
出处
《中国急救医学》
CAS
CSCD
2022年第4期285-292,共8页
Chinese Journal of Critical Care Medicine
基金
海南省自然科学基金高层次人才项目(2019RC212)
中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-023)
急救与创伤研究教育部重点实验室(海南医学院)开放课题基金(KLET-202005)
海南省哲学社会科学规划课题[HNSK(YB)19-67]。
