中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
1期
18-23
,共6页
崔金英%许焕力%王爱田%朱曦%么改琦%刘芳
崔金英%許煥力%王愛田%硃晞%麽改琦%劉芳
최금영%허환력%왕애전%주희%요개기%류방
脓毒症%复苏%含白蛋白液体%荟萃分析
膿毒癥%複囌%含白蛋白液體%薈萃分析
농독증%복소%함백단백액체%회췌분석
Sepsis%Resuscitation%Albumin-containing liquid%Meta-analysis
目的 通过比较白蛋白与其他液体对脓毒症患者复苏结果的影响,评估白蛋白液体复苏是否可以降低脓毒症患者病死率.方法 通过检索美国《医学索引》(MEDLINE)、生物医学与药理学文摘数据库(Embase)、Cochrane临床试验数据库、对照试验Meta注册(the metaRegister of Controlled Trials)、医学编辑试验拾遗注册(the Medical Editors Trial Amnesty Register).寻找比较含白蛋白液体复苏和其他液体复苏的随机对照临床试验(RCT)的相关文献.纳入研究人群为确诊脓毒症的成人患者,及包括脓毒症患者作为亚组的相关研究.用RevMan 5.0软件对纳入研究进行荟萃分析(Meta分析),主要结局指标是所有住院患者的病死率.结果 共纳入14项RCT,包括1729例患者接受了白蛋白或其他液体复苏.其中5项研究仅纳入脓毒症,另9项研究将脓毒症作为亚组.P=0.98,I2=0％,没有异质性,故使用固定效应模型合并结果.应用含白蛋白相关液体对脓毒症患者进行复苏与其他液体复苏相比病死率无明显差异[优势比(OR)为0.87,95％可信区间(95％CI)0.71～1.07,P=0.18]；其中高浓度白蛋白(20％)溶液复苏合并OR为1.11,95％CI0.71～1.73,P=0.65,低浓度白蛋白(4％、5％)溶液复苏合并OR为0.82,95％CI 0.65～1.03,P=0.09,不同浓度白蛋白溶液复苏与总体研究结果一致.本研究分别剔除了Boldt等人的6篇研究及生理盐水和白蛋白液体复苏评价(SAFE)研究后再进行敏感性分析,用以检测这些数据对总结果是否产生决定性意义,剔除7篇文献之后总结果没有变化(剔除Boldt等的研究:OR 0.82,95％CI0.65～1.02,P=0.08；剔除SAFE研究:OR 1.05,95％CI0.71～1.55,P=0.82),分析结果是稳健的.结论 脓毒症患者使用含白蛋白液体复苏与其他种类液体复苏相比没有降低病死率.
目的 通過比較白蛋白與其他液體對膿毒癥患者複囌結果的影響,評估白蛋白液體複囌是否可以降低膿毒癥患者病死率.方法 通過檢索美國《醫學索引》(MEDLINE)、生物醫學與藥理學文摘數據庫(Embase)、Cochrane臨床試驗數據庫、對照試驗Meta註冊(the metaRegister of Controlled Trials)、醫學編輯試驗拾遺註冊(the Medical Editors Trial Amnesty Register).尋找比較含白蛋白液體複囌和其他液體複囌的隨機對照臨床試驗(RCT)的相關文獻.納入研究人群為確診膿毒癥的成人患者,及包括膿毒癥患者作為亞組的相關研究.用RevMan 5.0軟件對納入研究進行薈萃分析(Meta分析),主要結跼指標是所有住院患者的病死率.結果 共納入14項RCT,包括1729例患者接受瞭白蛋白或其他液體複囌.其中5項研究僅納入膿毒癥,另9項研究將膿毒癥作為亞組.P=0.98,I2=0％,沒有異質性,故使用固定效應模型閤併結果.應用含白蛋白相關液體對膿毒癥患者進行複囌與其他液體複囌相比病死率無明顯差異[優勢比(OR)為0.87,95％可信區間(95％CI)0.71～1.07,P=0.18]；其中高濃度白蛋白(20％)溶液複囌閤併OR為1.11,95％CI0.71～1.73,P=0.65,低濃度白蛋白(4％、5％)溶液複囌閤併OR為0.82,95％CI 0.65～1.03,P=0.09,不同濃度白蛋白溶液複囌與總體研究結果一緻.本研究分彆剔除瞭Boldt等人的6篇研究及生理鹽水和白蛋白液體複囌評價(SAFE)研究後再進行敏感性分析,用以檢測這些數據對總結果是否產生決定性意義,剔除7篇文獻之後總結果沒有變化(剔除Boldt等的研究:OR 0.82,95％CI0.65～1.02,P=0.08；剔除SAFE研究:OR 1.05,95％CI0.71～1.55,P=0.82),分析結果是穩健的.結論 膿毒癥患者使用含白蛋白液體複囌與其他種類液體複囌相比沒有降低病死率.
목적 통과비교백단백여기타액체대농독증환자복소결과적영향,평고백단백액체복소시부가이강저농독증환자병사솔.방법 통과검색미국《의학색인》(MEDLINE)、생물의학여약이학문적수거고(Embase)、Cochrane림상시험수거고、대조시험Meta주책(the metaRegister of Controlled Trials)、의학편집시험습유주책(the Medical Editors Trial Amnesty Register).심조비교함백단백액체복소화기타액체복소적수궤대조림상시험(RCT)적상관문헌.납입연구인군위학진농독증적성인환자,급포괄농독증환자작위아조적상관연구.용RevMan 5.0연건대납입연구진행회췌분석(Meta분석),주요결국지표시소유주원환자적병사솔.결과 공납입14항RCT,포괄1729례환자접수료백단백혹기타액체복소.기중5항연구부납입농독증,령9항연구장농독증작위아조.P=0.98,I2=0％,몰유이질성,고사용고정효응모형합병결과.응용함백단백상관액체대농독증환자진행복소여기타액체복소상비병사솔무명현차이[우세비(OR)위0.87,95％가신구간(95％CI)0.71～1.07,P=0.18]；기중고농도백단백(20％)용액복소합병OR위1.11,95％CI0.71～1.73,P=0.65,저농도백단백(4％、5％)용액복소합병OR위0.82,95％CI 0.65～1.03,P=0.09,불동농도백단백용액복소여총체연구결과일치.본연구분별척제료Boldt등인적6편연구급생리염수화백단백액체복소평개(SAFE)연구후재진행민감성분석,용이검측저사수거대총결과시부산생결정성의의,척제7편문헌지후총결과몰유변화(척제Boldt등적연구:OR 0.82,95％CI0.65～1.02,P=0.08；척제SAFE연구:OR 1.05,95％CI0.71～1.55,P=0.82),분석결과시은건적.결론 농독증환자사용함백단백액체복소여기타충류액체복소상비몰유강저병사솔.
Objective To compare the effect of albumin as a resuscitation fluid with other fluids in lowering the mortality of patients with sepsis.Methods By searching MEDLINE,Embase,Cochrane Central Registration of Controlled Trials databases,the metaRegister of Controlled Trials,the Medical Editors Trial Amnesty Register,and retrieval of the randomized controlled trial (RCT) literature to compare the result of resuscitation using albumin-containing fluid and other fluids.The study population included adult patients who were diagnosed to have sepsis,and the patients with sepsis who were studied as subgroup.The RevMan 5.0 software was used for Meta-analysis,and the main outcome was the mortality of the hospitalized patients.Results In the 14 RCTs,1729 patients received the albumin-containing fluid resuscitation or resuscitation with other fluids.It was found that the patients with sepsis were the only research objects in five studies,and in other nine studies patients with sepsis were studied as subgroup.P=0.98,I2=0％,i.e.no heterogenicity,and the fixed effect model was used for combining results.There was no evident difference between the group of patients with sepsis resuscitated by albmin-containing fluids and other fluids [odds ratio (OR) was 0.87,95％ confidence interval (95％CI) 0.71-1.07,P=0.18].The pooled OR of resuscitation using high concentration albumin solution (20％) was 1.11,95％CI 0.71-1.73,P=0.65,the pooled OR of resuscitation using low concentration albumin solution (4％,5％ ) was 0.82,95％CI 0.65-1.03,P=0.09.Resuscitation with different concentration of albmin-containing fluids was identical with the whole research results.After rejecting six articles of Boldt and other authors,and also saline versus albumin fluid evaluation (SAFE) study,the sensitivity analysis of the study was performed in order to check whether the data produced decisive significance to the whole research results or not.The whole results did not change after their rejection( Boldt studies were rejected: OR 0.82,95 ％ CI 0.65 - 1.02,P=0.08; SAFE study was rejected: OR 1.05,95 ％ CI 0.71-1.55,P=0.82 ).Therefore the analysis results were satisfactory.Conclusion The Meta-analysis shows that by using albmin-containing fluids for resuscitation can not lower the mortality of sepsis as compared with other fluids.
