摘要目的 综合评价和对比单纯胸外按压心肺复苏(CCPR)与常规心肺复苏(SCPR)对院外心脏停搏(OHCA)患者的复苏效果.方法 检索美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、美国全球数据库提供商Ovid数据库、Cochrane图书馆数据库、万方数据库、中国知网数据库、维普信息资源数据库、中国生物医学文献数据库(CBM)从建库至2018年3月2日公开发表的所有对比CCPR与SCPR对OHCA患者复苏效果的队列研究.主要结局指标包括自主循环恢复(ROSC)率、出院存活率、神经系统功能良好率.由2名评价者各自独立检索、阅读符合入选条件的文献,独立进行信息采集,并评价文献质量.应用RevMan?5.3软件进行Meta分析,通过选择模型分析法与去除单项研究法进行敏感性分析.采用漏斗图评估发表偏倚.结果 共纳入10项队列研究、174?163例OHCA患者,其中接受CCPR?95?157例,SCPR?79?006例.纳入研究的纽卡斯尔-渥太华文献质量评价量表(NOS)评分8～9分,提示纳入文献质量均较高.Meta分析结果显示,与SCPR比较,CCPR对OHCA患者出院存活率和神经系统功能良好率均有明显改善〔出院存活率:相对危险度(RR)＝1.04,95%可信区间(95%CI)＝1.00～1.08,P＝0.04 ;神经系统功能良好率:RR＝1.11,95%CI＝?1.06～1.17,P＜0.000?1〕;而两组ROSC率比较差异无统计学意义(RR＝1.01,95%CI＝0.98～1.04,P＝0.52).亚组分析结果显示,两种CPR方法对心源性OHCA患者出院存活率的影响差异无统计学意义(RR＝1.13, 95%CI＝0.82～1.57,P＝0.45);但对于非心源性OHCA患者,SCPR组出院存活率明显优于CCPR组(RR＝0.88, 95%CI＝0.80～0.96,P＝0.004).在固定效应模型与随机效应模型下,上述指标分析结果一致,提示结果可靠且稳定性好.漏斗图分析结果显示,大部分研究呈左右对称的倒漏斗型分布,表明发表偏倚低,但由于纳入研究数量较少,故不能完全排除文献发表偏倚.结论 对于未进行OHCA病因分类的患者,CCPR在提高ROSC率、出院存活率及神经系统功能良好率方面不亚于SCPR,且CCPR在学习及旁观者施行意愿上更具优势;但在能明确为非心源性OHCA时,在条件允许的情况下建议行SCPR.

abstractsObjective To comprehensively evaluate and compare the resuscitation efficacy of chest-compression-only cardiopulmonary resuscitation (CCPR) and standard cardiopulmonary resuscitation (SCPR) for patients with out-of-hospital cardiac arrest (OHCA). Methods Databases such as PubMed, Embase, Ovid, Cochrane Library, Wanfang, CNKI, VIP, CBM were searched from the date of their foundation to March 2nd 2018, and the studies on the difference of effects between CCPR and SCPR for patients with OHCA were retrieved. The outcomes included the return of spontaneous circulation (ROSC) rate, survival to hospital discharge, neurological function completion rate. Two reviewers independently screened the literature meeting the inclusion criteria, independently collected information and evaluated the literature quality. Meta-analysis was conducted using RevMan 5.3 software, and sensitivity analysis was conducted by selecting model analysis method and removing single research method. Funnel plot was used to evaluate publication bias. Results A total of 10 cohort studies were included, including 174 163 patients with OHCA, of which 95 157 undergone CCPR and 79 006 undergone SCPR. The scores of the Newcastle-Ottawa scale (NOS) were 8-9, indicating that the quality of the literatures included was high. It was shown by the Meta-analysis that CCPR had the higher rate of survival to hospital discharge [relative risk (RR) = 1.04, 95% confidence interval (95%CI) = 1.00-1.08, P = 0.04] and neurological function completion (RR = 1.11, 95%CI = 1.06-1.17, P < 0.000 1) than SCPR, but there was no significant difference in ROSC rate between the two groups (RR = 1.01, 95%CI = 0.98-1.04, P = 0.52). In the subgroup, there was no statistical significance between CCPR and SCPR in the rate of survival to hospital discharge in cardiac OHCA patients (RR = 1.13, 95%CI = 0.82-1.57, P = 0.45). However, in non-cardiac OHCA group, SCPR showed more benefits than CCPR in improving the rate of survival to hospital discharge (RR = 0.88, 95%CI = 0.80-0.96, P = 0.004). The above analysis results were consistent in the fixed effect model and random effect model, indicating that the results were reliable and stable. It was shown by the funnel plot that most of the studies were left-right inverted funnel type, indicating a low publication bias. However, the bias could not be completely excluded due to the small number of included literatures. Conclusions For patients without OHCA etiological classification, CCPR was not less than SCPR in improving ROSC rate, discharge survival rate and good neurological function, and CCPR was more advantageous in learning and the willingness of bystanders to implement. However, when non-cardiogenic OHCA could be identified, SCPR should be recommended when conditions permit.