心脏骤停后保守氧疗目标与较高氧疗目标：系统评价、荟萃分析和试验序贯分析。
完整摘要 · 中文译文
背景：自主循环恢复（ROSC）后的最佳氧合状态仍不确定，因为低氧血症和高氧血症都有继发性损伤的风险。我们进行了一项更新的系统评价和荟萃分析，比较限制性氧疗目标与较高氧疗目标的疗效。 方法：按照PRISMA 2020方案，从数据库建库至2026年6月进行了一项系统评价和荟萃分析。仅纳入研究限制性氧疗与较高氧疗对接受有创机械通气的成人心脏骤停（CA）患者影响的随机对照试验。使用RoB 2和GRADE工具评估偏倚风险和证据质量。采用随机效应模型进行数据合成，并以RR/MD表示结果。 结果：共纳入11项随机对照试验（12篇报告），涉及4136名受试者。限制性氧疗在全因死亡率（RR 0.96，95% CI 0.88-1.06）或不良神经学结局（RR 0.96，95% CI 0.88-1.04）方面均无显著差异。大多数亚组分析无显著差异，但严格低温亚组（33°C-34°C）的死亡率降低除外，尽管试验序贯分析（TSA）显示证据不稳定。次要结局未见显著差异。限制性氧疗增加了低氧血症风险（RR 1.65），但改善了无呼吸机天数（MD 2.14）。 结论：与较高氧疗相比，成人心脏骤停（CA）患者采用限制性氧疗在总体死亡率、神经学结局或任何其他主要临床终点方面均无显著改善。在当前常温（36°C-37.5°C）方案下，累积证据趋向于限制性策略无效，尽管确定性信息量尚未完全累积。尽管限制性氧合水平可能导致无呼吸机天数增加，但低氧血症风险也会增加。
完整摘要 · 英文原文
BACKGROUND: Optimal oxygenation following return of spontaneous circulation (ROSC) remains uncertain, as both hypoxemia and hyperoxemia risk secondary injury. We conducted an updated systematic review and meta-analysis comparing the efficacy of restrictive versus higher oxygenation targets. METHODS: A systematic review and meta-analysis following the PRISMA 2020 protocol was carried out from database inception through June 2026. Only RCTs examining the impact of restrictive oxygenation versus higher oxygenation for adult CA patients undergoing invasive mechanical ventilation were included. Risks of bias and the quality of the evidence were evaluated using RoB 2 and GRADE tools. A random-effects model was used for data synthesis and presented the results in RR/MD. RESULTS: Eleven RCTs (12 reports) involving 4136 participants were included. Restrictive oxygenation showed no significant difference in all-cause mortality (RR 0.96, 95% CI 0.88-1.06) or unfavorable neurological outcomes (RR 0.96, 95% CI 0.88-1.04). Most subgroup analyses were non-significant, except for reduced mortality in the strict hypothermia subgroup (33°C-34°C), although TSA showed unstable evidence. No significant differences were observed in secondary outcomes. Restrictive oxygenation increased hypoxemia risk (RR 1.65) but improved ventilator-free days (MD 2.14). CONCLUSION: There is no significant improvement in overall mortality, neurological outcome, or any other major clinical endpoint in adult CA patients with restrictive oxygen compared to higher oxygen therapy. Under current normothermia (36°C-37.5°C) protocols, the accumulated evidence trends toward futility for a restrictive approach, though the definitive information size has not yet been entirely accrued. Although restrictive levels could lead to an increased number of ventilator-free days, there will be an increased risk of hypoxemia.