摘要
目的系统评价高渗盐水在脓毒症、脓毒性休克液体复苏中的安全性。方法计算机检索Pub Med、EMBASE、Cochrane图书馆、中国知网和万方数据库,收集应用高渗盐水进行脓毒症、脓毒性休克液体复苏的随机对照试验,检索时限均为从建库至2016-07月。由2位研究者独立根据纳入与排除标准筛选文献、提取资料并对所纳入研究的方法学质量进行评价后,应用Revman 5.3.5软件进行Meta分析。结果共纳入5个研究,包含208例患者。Meta分析结果显示:高渗盐水组与0.9%生理盐水组28 d死亡率[RR=1.02,95%CI(0.79,1.32),P=0.86]、早期目标导向治疗(early goal-directed therapy,EGDT)达标率[RR=1.11,95%CI(0.94,1.31),P=0.22]、升压药物使用情况[RR=1.01,95%CI(0.89,1.16),P=0.84]、升压药物使用超过3 d情况[RR=0.95,95%CI(0.76,1.20),P=0.68]无统计学差异;但高渗盐水组输液量明显低于0.9%生理盐水组[MD=-1 097.90,95%CI(-1 295.26,-900.53),P<0.000 01]。结论高渗盐水液体复苏在28 d死亡率、EGDT达标率和升压药物使用方面同0.9%生理盐水比较无统计学差异,但高渗盐水组总液体输入量明显低于生理盐水组。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the safety of hypertonic saline solution as fluid resuscitation for patients with sepsis and septic shock. Methods Datebase from PubMed, Embase, Cochrane library, China National Knowledge Infra- structure （CNKI） and Wanfang database were selected to randomized controlled trail about hypertonic saline as fluid re- suscitation therapy for patients with sepsis and septic shock from inception to July 2016 . Two reviewers independently screened literatures according to inclusion and excluding criteria, extracted data, assessed methodological qualities of included studies,and conducted a meta-analysis by using RevMan 5.3.5 software. Results Five studies were selected and included 208 patients. Meta analysis results showed no differences were found in 28-day mortality [RR = 1.02,95% CI （0. 79,1.32）, P = 0. 861, achieved rate of early goal-directed therapy （EGDT） 1-RR = 1.11,95 % CI （0. 94, 1.31 ）, P = 0. 221, use of hyperensort [-RR = 1.01,95 %CI （0. 89,1.16）,P = 0. 84-], use of hyperensort more than 3 daysERR = 0. 95, 95%CI （0. 76,1.20） ,P = 0. 681 between hypertonic saline solution group and 0. 9% saline solution group. However, total fluid volume in hypertonic saline solution group was lower than that in 0. 9% saline solution group EMD = - 1 097.90, 95 %CI （ - 1 295.26, - 900. 53）, P〈0. 000 01]. Conclusion No significantly differences are found in 28-day mortality, a- chieved rate of EGDT and uses of hyperensort between hypertonic saline solution group and 0. 9% saline solution group. However, total fluid volume in hypertonic saline solution group was lower than that in 0.9% saline solution group. The results of meta-analysis are restricted to quantities and qualities of included studies. This conclusion still needs more high quality studies to verify.
作者
梁宇鹏
李洁
赵鑫
张国秀
LIANG Yu-peng LI J ie ZHAO Xin ZHANG Guo-xiu(Department of Emergency, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang He＇nan 471003 ,China)
出处
《华南国防医学杂志》
CAS
2017年第5期324-328,共5页
Military Medical Journal of South China
关键词
脓毒症
液体复苏
高渗盐水
随机对照试验
荟萃分析
Sepsis
Fluid resuscitation
Hypertonic saline
Randomized controlled trails
Meta-analysis
