摘要
目的:系统评价低剂量普通肝素(UFH)用于体外膜肺氧合(ECMO)辅助支持患者的抗凝治疗。方法:计算机检索PubMed、EMbase、Cochrane Library、CNKI、维普、万方和CBM数据库,纳入低剂量UFH用于ECMO辅助支持患者抗凝的回顾性队列研究。根据NOS量表对纳入研究的质量进行评价。采用RevMan 5.3软件进行Meta分析。结果:共计纳入5篇文献,包括469例患者,试验组(UFH低剂量)215例,对照组(UFH常规剂量)254例。NOS评分为7~9分。Meta分析结果显示,试验组和对照组的ECMO血管插管部位出血发生率分别为15.22%和40.74%,胃肠出血发生率分别为7.32%和14.62%,差异均有统计学意义(P<0.05);与对照组相比,试验组的压缩红细胞(PRBC)平均输注单位显著减少(P<0.01)。两组的手术部位出血、肺出血、颅内出血、血栓形成、ECMO撤机以及在院死亡率均无统计学差异(P>0.05)。结论:对于ECMO辅助支持患者,UFH调低剂量可减少ECMO血管插管部位和胃肠等部分出血事件,降低PRBC平均输注单位。且尚无证据表明,调低UFH剂量会增加患者的血栓形成,延缓ECMO撤机,甚至提高在院死亡率。受纳入研究质量及数量的限制,研究结果仍需更多大样本、高质量的研究加以验证。
Objective: To systematically review the anticoagulant regimen of low-dose unfractioned heparin(UFH) for patients on extracorporeal membrane oxygenation(ECMO). Methods: Databases including PubMed, EMbase, Cochrane Library, CNKI, VIP, Wanfang and CBMdisc were searched for retrospective cohort studies about low-dose UFH used for patients on ECMO. Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the included studies. Meta-analysis was conducted by RevMan 5.3 software. Results: A total of 5 cohort studies with a NOS score of 7 – 9 and 469 patients were included. There were 215 patients in experimental group(low-dose of UFH) and 254 patients in control group(routine dose of UFH). Results of meta-analysis showed that the rates of ECMO cannula site bleeding in experimental group and control group were 15.22% and 40.74% respectively, rates of gastrointestinal bleeding in the two groups were 7.32% and 14.62% respectively. There were significant differences between them(P < 0.05). Compared with the control group, mean transfusion units of packed red blood cell( PRBC) markedly declined( P < 0.01) in experimental group. Meanwhile, there were no statistical differences in rates of surgical site bleeding, pulmonary bleeding, cerebral bleeding, thrombosis, weaning of ECMO and in-hospital mortality between the two groups( P > 0.05). Conclusion: For the patients on ECMO, low-dose UFH might help reduce the rates of cannula site bleeding, gastrointestinal bleeding, mean transfusion units of PRBC and had no influences on thrombosis, weaning of ECMO and the in-hospital mortality, which should be further proved by more studies with high quality due to the limitation of the quality and quantity of cohort studies involved in this study.
作者
黄晓婧
赵红卫
马永成
杜鹏强
倪铭
王爱凤
HUANG Xiao-jing;ZHAO Hong-wei;MA Yong-cheng;DU Peng-qiang;NI Ming;WANG Ai-feng(pepartment of Pharmacy,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450000,China)
出处
《中国药物应用与监测》
CAS
2020年第6期355-359,共5页
Chinese Journal of Drug Application and Monitoring
基金
吴阶平医学基金会临床药学专项基金(3206750190904)。
关键词
普通肝素
低剂量
体外膜肺氧合
抗凝
系统评价
Unfractioned heparin
Low dose
Extracorporeal membrane oxygenation
Anticoagulation
Systematic review
