作者：谭品义，孙珺俊，庞文龙，韦雪，李贵源，莫凡睿，韦美发

单位：

1.545100广西壮族自治区柳州市柳江区人民医院心血管内科　2.545027广西壮族自治区柳州市工人医院心血管内科

Units：

1.Department of Cardiology, Liujiang District People's Hospital, Liuzhou 545100, China2.Department of Cardiocogy, Liuzhou Worker's Hospital, Liuzhou 545027, China

关键词：

猝死，心脏；心搏骤停；心肺复苏术；碳酸氢钠；Meta分析

Keywords：

Death, sudden, cardiac; Sudden cardiac arrest; Cardiopulmonary resuscitation; Sodium bicarbonate;Meta-analysis

CLC：

R 541

DOI：

10.12114/j.issn.1008-5971.2023.00.219

Funds：

柳州市科技计划项目（柳科攻2021CBC0124）

摘要：

目的　系统评价成人心搏骤停患者心肺复苏（CPR）期间碳酸氢钠（SB）的应用效果。方法　计算机检索PubMed、Cochrane Library、Web of Science、Embase及中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网发表的成人心搏骤停患者CPR期间应用SB效果的随机对照试验（RCT）和回顾性研究，检索时间从建库至2023-03-12。根据患者CPR期间是否采用SB治疗分为SB治疗组与无SB治疗组，应用Stata 16.0软件进行Meta分析，比较SB治疗组与无SB治疗组自发性循环恢复（ROSC）率、出院生存率、持续ROSC（ROSC时间＞20 min）率及pH值好转率。结果　本研究最终纳入11篇文献，其中RCT 5篇、回顾性研究6篇；包括19 173例患者，其中SB治疗组7 782例、无SB治疗组11 391例。Meta分析结果显示，SB治疗组与无SB治疗组ROSC率〔OR=1.03，95%CI（0.65，1.64）〕和出院生存率〔OR=0.48，95%CI（0.14，1.67）〕比较，差异无统计学意义（P＞0.05）；SB治疗组持续ROSC率低于无SB治疗组〔OR=0.27，95%CI（0.07，0.98），P＜0.05〕，pH值好转率高于无SB治疗组〔OR=4.56，95%CI（1.88，11.03），P＜0.05〕。亚组分析结果显示，在其他国家（除中国外），无SB治疗组ROSC率高于SB组〔OR=0.51，95%CI（0.43，0.60），P＜0.05〕。敏感性分析结果显示，CHUNG等研究的统计学异质性较高。结论　SB治疗可以纠正成人心搏骤停患者CPR期间酸中毒情况，但对提高ROSC率、出院生存率无明显益处，甚至不利于持续ROSC。

Abstract：

Objective To systematically evaluate the application effect of sodium bicarbonate (SB) duringcardiopulmonary resuscitation (CPR) in adult patients with sudden cardiac arrest. Methods PubMed, Cochrane Library, Webof Science, Embase, CNKI, CBM, Wanfang Data, and VIP were searched for randomized controlled trials (RCT) and retrospectivestudies on the effect of SB during CPR in adult patients with sudden cardiac arrest. The search time was from the establishmentof the database to March 12, 2023. According to whether SB treatment was used during CPR, the patients were divided into SBtreatment group and non-SB treatment group. Meta-analysis was performed using Stata 16.0 software to compare the return ofspontaneous circulation (ROSC) rate, survival rate at discharge, continuous ROSC (ROSC time > 20 min) rate and pH improvementrate between SB treatment group and non-SB treatment group. Results Finally, 11 articles were included in this study, including5 RCTs and 6 retrospective studies; there were 19 173 patients, including 7 782 cases in the SB treatment group and 11 391cases in the non-SB treatment group. The results of Meta-analysis showed that there was no significant difference in ROSC rate[OR=1.03, 95%CI (0.65, 1.64) ] and survival rate at discharge [OR=0.48, 95%CI (0.14, 1.67) ] between SB treatment group andnon-SB treatment group (P > 0.05) ; the rate of continuous ROSC in SB treatment group was lower than that in non-SB treatmentgroup [OR=0.27, 95%CI (0.07, 0.98) , P < 0.05] , and the improvement rate of pH value was higher than that in non-SB treatmentgroup [OR=4.56, 95%CI (1.88, 11.03) , P < 0.05] . Subgroup analysis showed that in other countries (except for China) , the ROSCrate in the non-SB treatment group was higher than that in the SB treatment group [OR=0.51, 95 %CI (0.43, 0.60) , P < 0.05] . Theresults of sensitivity analysis showed that the statistical heterogeneity of CHUNG et al. was high. Conclusion SB treatment cancorrect acidosis during CPR in adult patients with sudden cardiac arrest, but it has no significant benefit in improving ROSC rate and survival rate at discharge, and even is not conducive to continuous ROSC.

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