摘要
目的探讨超滤治疗对急性心力衰竭患者肾功能和预后的影响。方法通过检索Pubmed、EMBASE数据库、Cochrane图书馆、Cochrane临床试验中心注册库及中文万方数据库，检索超滤治疗对急性心力衰竭患者预后影响的随机对照研究文献，按照PRISMA声明筛选文献，分析超滤治疗对急性心力衰竭患者肾功能和预后的影响。结果最终纳入12项临床研究1070例患者。与应用常规利尿剂组比较，超滤治疗对急性心力衰竭患者的血肌酐水平[标准均数差（SMD）=-0．18，95％CI：-0．47～0．10，P=0．21]、肾小球滤过率（SMD=-0．38，95％CI：-1．03～0．27，P=0．25）和肾衰竭发生率（RR=1．25，95％CI：0．88～1．77，P=0．21）均无显著影响，但超滤治疗能降低血钠水平（SMD=-0．38，95％CI：-0．67～-0．08，P-0．01），增加液体排出总量（SMD-1．06，95％CI：0．29～1．83，P-0．007）和降低体重（SMD=-1．34，95％CI：-1．98～～0．71，P〈0．001）。结论虽然超滤治疗可促进液体排出，减轻液体潴留，但对急性心力衰竭患者的肾功能和肾衰竭发生风险无明显影响。
Objective To evaluate the effect of ultrafiltration on the renal function in the treatment of patients with acute heart failure. Methods We retrieved as high a proportion as possible of relevant randomized controlled trials （RCT） from PubMed, EMBASE, Cochrane Library, Cochrane clinic test center registration bank and Wanfang database. This meta-analysis was performed by searching RCT study literatures on the prognosis of patients with acute heart failure treated with ultrafiltration and by screening the search results according to the PRISMA declaration. Results We identified 12 RCTs with a total of 1,070 participants involved. Overall, as compared with routine diuretics treatment, ultrafiltration treatment did not significantly affect the serum ereatinine levels [standard mean difference （SMD = -- 0.18,95% CI ： -- 0.47 to 0.10, P = 0.21）], the estimated glomerular filtration rate （SMD= --0.38,95% CI： -1.03 to 0. 27,P =0.25） ,and the incidence rate of renal failure （RR = 1.25,95% CI： 0. 88 to 1.77, P = 0.21）. But, ultrafiltration treatment was associated with decreased serum sodium level （SMD = -- 0.38,95 % CI ： 0. 67 to 0.08, P = 0.01） ,increased net fluid extraction volume （SMD = 1.06,95 % CI ： 0.29 to 1.83, P = 0. 007）, and decreased body weight （SMD = -- 1.34, 95% CI： -- 1.98 to -- 0.71, P 〈 0.001） Conclusions Although ultrafiltration increases the fluid extraction and decreases the fluid retention,the renal function and risk of renal failure in patients with acute heart failure are not significantly changed.
作者
时秋宽
李鹏
于普林
Shi Qiukuan;Li Peng Yu Pulin(The Journal Editorial Office of Beijing Hospital, National Center of Gerontology ,Beijing 100730, China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2018年第7期821-825,共5页
Chinese Journal of Geriatrics
关键词
超滤
心力衰竭
肾机能不全
Ultrafiltration
Heart failure
Renal insufficiency
