CAJ | 학술논문

目的评价限制性液体管理对急性肺损伤患者预后的影响.方法采用Cochrane系统评价的方法,通过计算机和手工检索收集国内外1990年1月1日至2010年5月20日关于限制性液体管理对急性肺损伤患者预后的随机对照研究(RCT)、病例对照研究.结果共纳入4项RCT和3项回顾性对照研究.4项RCT研究共1178例患者,包括限制性液体管理组594例,对照组584例,与对照组相比,限制性液体管理不能显著降低急性肺损伤患者的病死率(P=0.16).3项回顾性对照研究共1046例患者,包括实现限制性液体管理296例,对照组750例,统计显示实现限制性液体管理者病死率明显低(P＜0.001).对4项RCT研究进一步分析显示,限制性液体管理可缩短机械通气时间,不会显著增加肾功能损害.结论限制性液体管理不能明显降低急性肺损伤患者的病死率,但可以缩短机械通气时间,仍有必要进行更多大样本、高质量的RCT研究.
목적 평개한제성액체관리대급성폐손상환자예후적영향.방법 채용Cochrane계통평개적방법,통과계산궤화수공검색수집국내외1990년1월1일지2010년5월20일관우한제성액체관리대급성폐손상환자예후적수궤대조연구(RCT)、병례대조연구.결과 공납입4항RCT화3항회고성대조연구.4항RCT연구공1178례환자,포괄한제성액체관리조594례,대조조584례,여대조조상비,한제성액체관리불능현저강저급성폐손상환자적병사솔(P=0.16).3항회고성대조연구공1046례환자,포괄실현한제성액체관리296례,대조조750례,통계현시실현한제성액체관리자병사솔명현저(P＜0.001).대4항RCT연구진일보분석현시,한제성액체관리가축단궤계통기시간,불회현저증가신공능손해.결론 한제성액체관리불능명현강저급성폐손상환자적병사솔,단가이축단궤계통기시간,잉유필요진행경다대양본、고질량적RCT연구.
Objective To evaluate the effect of conservative fluid management on the outcomes in patients with acute lung injury (ALI). Methods Randomized controlled trials (RCTs) and cohort trials on conservative fluid management from January 1, 1990 to May 20, 2010 were retrieved by electronic and manual searching. A meta-analysis of effect of conservative fluid management on the outcomes in ALI patients was conducted by the methods as recommended by the Cochrane Collaboration. Results Four RCTs involving 594 cases in conservative fluid management group and 584 in conventional fluid management group were included into the Meta-analysis. Compared with the conventional fluid management group, there was no beneficial effect of conservative fluid management strategy on mortality in ALI patients (P = 0. 16) .However, the duration of mechanical ventilation was shortened while the incidence of renal failure remained unchanged. Three retrospective cohort trials involving 296 cases in conservative fluid management group and 750 in conventional fluid management group were included into the meta-analysis. As compared with the conventional fluid management strategy, conservative fluid management strategy had improved the patient outcomes (P ＜0.001). Conclusion No beneficial effect of conservative fluid management strategy on the mortality is observed in the ALI patients. And the ventilator-free durations become elongated. However,further trials of a larger sample size and a higher quality are warranted.