论文部分内容阅读
目的:评价第一目击者在对院前心脏骤停(out-of-hospital cardiac arrest,OHCA)患者进行心肺复苏(cardiopulmonary resuscitation,CPR)时是否接受调度员指导(dispatcher-assisted cardiopulmonary resuscitation，DA-CPR)对OHCA患者结局是否有影响。方法:通过检索在中文及英文各大数据库公开发表的临床研究，筛选出关于对院前心脏骤停患者心肺复苏时是否进行DA-CPR的文献,按照Cochrane Handbook5.1.0标准，对纳入文献质量进行评价，并提取出相关有效数据，应用Review Manager 5.3软件，对三个结局指标（自主循环恢复、存活至出院、神经功能良好）分别进行Meta分析。结果:共纳入21项研究，共计349 822例患者，其中DA-CPR组182 125人，CPR-Only组167 697人。分析结果显示:在美国、日本、韩国，DA-CPR相比CPR-Only未能提高OHCA停患者的ROSC率，n RR=1.10，95% n CI: 0.94~1.29, n P=0.24；未能提高OHCA患者的出院存活率，n RR=1.10，95% n CI: 0.90~1.34 , n P=0.34；未能提高OHCA患者的神经功能良好率，n RR=1.01，95% n CI: 0.79~1.28, n P=0.97。而在中国，DA-CPR相比CPR-Only，能提高OHCA患者的ROSC率，n RR=2.61，95% n CI: 1.53~4.46, n P=0.0005；能提高OHCA患者的出院存活率，n RR=6.08，95% n CI: 1.84~20.04, n P=0.003；能提高OHCA患者的神经功能良好率，n RR=9.76，95% n CI: 1.87~51.02, n P=0.007。n 结论:DA-CPR在世界总体范围内的效果无统计学意义。但因发现DA-CPR在不同国家的效果差别较大，所以需具体而言：在发达国家，DA-CPR与无调度员指导的BCPR相比，不能明显提高OHCA患者的ROCS率、出院生存率和神经功能良好率。而在提高我国OHCA患者的ROCS率、出院生存率和神经功能良好率方面，DA-CPR优于无调度员指导的BCPR，有统计学意义。“,”Objective:To evaluate the outcome of the patients receiving dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) delivered by first-responders who witnessed the out-of-hospital cardiac arrest (OHCA) before the Emergency Medical Service (EMS) arrived.Methods:We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Meta-analysis was performed on three outcome indicators (recovery of spontaneous circulation survival to hospital discharge and survival with favourable neurologic outcome) using the Revman5.3 software.Results:A total of 21 studies with 349 822 patients were selected for the meta-analysis, including 182 125 patients in the DA-CPR group and 167 697 in the CPR-only group. The meta-analysis showed no significant difference between the DA-CPR and CPR-only groups in ROSC [n RR=1.10, 95% confidence interval (n CI): 0.94-1.29, n P=0.24], survival to hospital discharge (n RR=1.10, 95% n CI: 0.90-1.34, n P=0.34) and survival with favourable neurologic outcome (n RR=1.01, 95% n CI: 0.79-1.28, n P=0.97) of the patients in America, Japan and Korea. However, there was a significant difference between the DA-CPR and the CPR-only groups in ROSC (n RR=2.61, 95% n CI:1.53-4.46, n P=0.0005), survival to hospital discharge(n RR=6.08, 95% n CI: 1.84-20.04, n P=0.003), and survival with favourable neurologic outcome(n RR=9.76, 95%n CI: 1.87-51.02, n P=0.007) of the patients in China.n Conclusions:The overall effect of DA-CPR is significantly different for each country. In detail, DA-CPR offers a survival advantage (Return of spontaneous circulation, survival to hospital discharge and survival with favourable neurologic outcome) over CPR alone in China but no advantage in developed countries.