Objective: To evaluate the prognostic impact of neuromuscular blocking agents (NMBA) on patients with acute respiratory distress syndrome (ARDS). Method: Online search of MEDLINE, Embase, Web of Science, CNKI, CBM and other Chinese databases for randomized controlled trials (RCTs) of NMBA in patients with ARDS from January 1994 to June 2019 was done, and literature was selected according to inclusion and exclusion criteria. The patients were divided into NMBA group and non-NMBA group according to whether NMBA was adopted or not. The prognostic indicators (ICU mortality, 28 d mortality, 90 d mortality) and NMBA-related complications (ICU acquired muscle weakness, barometric injury, pneumothorax) of the patients in the two groups were mainly analyzed. Meta-analysis of the data was performed using RevMan 5.0 software. Results: A total of 6 RCTs were included, and 1 502 patients were enrolled, including 761 in the NMBA group and 741 in the no-NMBA group. The 90-day mortality in the NMBA group and no-NMBA group were 38.8% and 42.6%, OR=0.87 (95%CI: 0.70-1.07, P=0.190); the 28-day mortality rates were 32.5% and 36.5%, OR=0.71 (95%CI: 0.45-1.11, P=0.130); ICU mortality rates were 31.8% and 43.8%, OR=0.60 (95%CI: 0.41-0.88, P=0.009). Conclusion: NMBA can reduce the ICU mortality of moderate to severe ARDS patients, but not reduce 28-day and 90-day mortality.
目的： 系统评价神经肌肉阻滞剂（NMBA）对急性呼吸窘迫综合征（ARDS）患者预后的影响。 方法： 联机检索Medline、Embase、Web of Science、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库等中英文数据库，收集1994年1月至2019年6月NMBA治疗ARDS的中英文临床随机对照研究（RCT）文献，按纳入与排除标准选择文献，按照是否应用NMBA将患者分为NMBA组和非NMBA组，主要分析两组患者预后指标（主要指标：90 d病死率，次要指标：ICU病死率、28 d病死率）以及NMBA相关并发症指标（ICU获得性肌无力、气压伤、气胸），对文献进行质量评价后，应用RevMan 5.0软件进行数据处理。 结果： 共纳入6篇临床RCT文献，入选患者1 502例，其中NMBA组761例，非NMBA组741例。NMBA组和非NMBA组ARDS患者90 d病死率分别为38.8%和42.6%，OR=0.87（95%CI：0.70~1.07，P=0.190）；28 d病死率分别为32.5%和36.5%，OR=0.71（95%CI：0.45~1.11，P=0.130）；ICU病死率分别为31.8%和43.8%，OR=0.60（95%CI：0.41~0.88，P=0.009）。 结论： NMBA有助于降低中重度ARDS患者ICU病死率，但不能降低其28 d和90 d病死率。.
Keywords: Acute Respiratory Distress Syndrome; Meta-analysis; Neuromuscular Blocking Agents; Prognosis.