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目的系统评价肥胖对急性呼吸窘迫综合征(acute respiratory aistress syndrome,ARDS)临床预后的影响。方法通过计算机检索Pubmed、EMBASE、Cochrane databases、Wiley、Ovid、Medline、CNKI、VIP、Wanfang数据库中关于肥胖与ARDS及急性肺损伤(acute lung injury,ALI)临床预后的相关文献,运用RevMan5.0及Stata10.0软件进行统计学分析。结果本Meta分析共纳入9篇文献,28368例患者。分析结果显示:肥胖显著降低ARDS的死亡率[OR=0.63,95%可信区间(95%CI)0.41~0.98,P=0.04]。亚组分析结果显示:与正常体重ARDS患者比较,肥胖患者在28d死亡率未见明显差异(OR=0.92,95%CI 0.55~1.54,P=0.76),但是在60d及90d死亡率均明显减低(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)。与正常体重ARDS患者比较,肥胖患者的住院时间及ICU时间延长,机械通气时间缩短,但无统计学意义[住院时间:加权均数差(weighted mean difference,WMD)=3.61,95%CI-0.36~7.57,P=0.07;重症监护病房(intensive care unit,ICU)时间:WMD=1.52,95%CI-0.22~3.26,P=0.09;机械通气时间:WMD=-0.50,95%CI-2.18~1.19,P=0.56]。此外,肥胖患者无需呼吸机辅助呼吸的时间延长(WMD=2.68,95%CI 0.86~4.51,P=0.004)。结论肥胖对ARDS患者的住院时间、ICU时间及机械通气时间无显著影响,但无需呼吸机辅助时间延长,60 d和90 d死亡率显著降低。上述结论需要更多大样本临床随机对照试验加以证实。
Objective To evaluate the effect of obesity on clinical prognosis of acute respiratory distress syndrome (ARDS). Methods The related literature about the clinical prognosis of obesity and ARDS and acute lung injury (ALI) in Pubmed, EMBASE, Cochrane databases, Wiley, Ovid, Medline, CNKI, VIP and Wanfang databases was searched by computer. Stata10.0 software for statistical analysis. Results The meta-analysis included 9 articles and 28,368 patients. The analysis showed that obesity significantly reduced the mortality of ARDS [OR = 0.63, 95% confidence interval (95% CI 0.41 to 0.98, P = 0.04]. The subgroup analysis showed that there was no significant difference in obese patients at 28 days (OR = 0.92, 95% CI 0.55-1.54, P = 0.76), but the death rates at 60 d and 90 d were significantly lower than those with ARDS (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). Obese patients had longer hospital stay and longer ICU and shorter duration of mechanical ventilation compared with patients with ARDS at normal weight but with no significant difference [length of stay: weighted mean difference (WMD) = 3.61, 95% CI-0.36 ~ 7.57, P = 0.07; ICU time: WMD = 1.52, 95% CI -0.22 ~ 3.26, P = 0.09; Mechanical ventilation time: WMD = -0.50, 95% CI-2.18 ~ 1.19, P = 0.56]. In addition, obese patients did not need ventilator-assisted breathing longer (WMD = 2.68, 95% CI 0.86-4.51, P = 0.004). Conclusion Obesity has no significant effect on the length of hospital stay, ICU time and duration of mechanical ventilation in patients with ARDS. However, the duration of ventilator-assisted time is not obvi- ous, and the mortality at 60 d and 90 d is significantly reduced. The above conclusion needs more large-scale clinical randomized controlled trials to be confirmed.