体外膜肺氧合器接受者康复训练干预时机的系统评价与荟萃分析。
完整摘要 · 中文译文
目的：系统评价早期与延迟康复训练干预（RTI）对接受体外膜肺氧合（ECMO）治疗患者临床结局的影响。 方法：我们开展了一项系统评价和荟萃分析，纳入比较接受ECMO治疗患者早期与延迟RTI的随机对照试验（RCT）、非随机对照研究和观察性队列研究。我们检索了Embase、PubMed、Web of Science、ScienceDirect、中国知网、中国科技期刊数据库和中国生物医学文献数据库等数据库，检索时间自建库至2025年4月1日。研究筛选、数据提取和质量评价由两名评价者独立完成。结局包括并发症、重症监护病房（ICU）和住院时间（LOS）、机械通气持续时间、ECMO持续时间和院内死亡率。 结果：共纳入12项研究（5项RCT、4项非RCT和3项队列研究）。与延迟RTI相比，早期RTI显著降低并发症风险[风险比（RR）= 0.43，95% CI：0.26-0.69，P < 0.001]，缩短ICU LOS[均数差（MD）= -1.12天，95% CI：-1.30至-0.94，P < 0.001]，并缩短住院LOS（MD = -4.69天，95% CI：-8.11至-1.27，P = 0.007）。机械通气持续时间（MD = 0.14天，P = 0.914）、ECMO持续时间（MD = -1.77天，P = 0.136）或院内死亡率（RR = 0.72，P = 0.097）均未发现显著差异。排除一项研究的敏感性分析显示更大的 住院时间（LOS）缩短具有显著性（MD = -5.82天，95% CI：-9.34至-2.30，P = 0.001），而其他结局保持不变。 结论：与延迟气管切开（RTI）相比，早期RTI与ECMO患者并发症减少及恢复结局（ICU/住院时间）改善相关。然而，由于纳入研究数量有限且质量中等，这些发现应谨慎解读。需要高质量随机对照试验（RCT）来证实这些结果。 系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251025533，PROSPERO CRD420251025533。
完整摘要 · 英文原文
OBJECTIVE: To systematically evaluate the effects of early versus delayed rehabilitation training interventions (RTI) on clinical outcomes in patients receiving extracorporeal membrane oxygenation (ECMO). METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), non-randomized controlled studies, and observational cohort studies comparing early and delayed RTI in patients receiving ECMO. We searched databases including Embase, PubMed, Web of Science, ScienceDirect, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc from inception to 1 April 2025. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Outcomes included complications, intensive care unit (ICU) and hospital length of stay (LOS), duration of mechanical ventilation, ECMO duration, and in-hospital mortality. RESULTS: Twelve studies (five RCTs, four non-RCTs, and three cohort studies) were included. Compared with delayed RTI, early RTI significantly reduced the risk of complications [risk ratio (RR) = 0.43, 95% CI: 0.26-0.69, P < 0.001], shortened ICU LOS [mean difference (MD) = -1.12 days, 95% CI: -1.30 to -0.94, P < 0.001], and reduced hospital LOS (MD = -4.69 days, 95% CI: -8.11 to -1.27, P = 0.007). No significant differences were found in mechanical ventilation duration (MD = 0.14 days, P = 0.914), ECMO duration (MD = -1.77 days, P = 0.136), or in-hospital mortality (RR = 0.72, P = 0.097). Sensitivity analysis excluding one study demonstrated a greater reduction in hospital LOS significant (MD = -5.82 days, 95% CI: -9.34 to -2.30, P = 0.001), while other outcomes remained unchanged. CONCLUSIONS: Early RTI is associated with reduced complications and improved recovery outcomes (ICU/hospital stay) in ECMO patients compared with delayed RTI. However, due to the limited number and moderate quality of included studies, these findings should be interpreted with caution. High-quality RCTs are needed to confirm these results. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251025533, PROSPERO CRD420251025533.