CAJ | 학술논문

背景：血液透析疗法是治疗急性肾功能衰竭的重要手段，其目的可清除过多的水分及毒素，维持患者体内的酸碱平衡，为患者用药及营养治疗创造条件，同时避免患者出现多脏器功能衰竭。目的：系统评价碳酸氢盐透析液与乳酸盐透析液在急性肾功能衰竭患者血液透析中的临床疗效及应用价值。方法：应用计算机检索PubMed、EMBASE、SCI、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库及中华医学会数字化期刊，收集碳酸氢盐透析液与乳酸盐透析液在急性肾功能衰竭患者血液透析中的随机对照试验，检索时间截止至2014年1月。采用Cochrane系统评价手册文献质量评价标准评价纳入研究质量，用RevMan 5.1软件进行Meta分析。结果与结论：共纳入4个随机对照试验，171例患者。Meta分析结果显示，碳酸氢盐透析液组心血管并发症、症状性低血压事件及血清乳酸盐水平低于乳酸盐透析液组(P<0.05)，两组病死率、血清碳酸氢盐水平、血清肌酐、pH和pCO2等方面差异无统计学意义。当前证据表明，与乳酸盐透析液相比，碳酸氢盐透析液可降低心血管并发症，减少症状性低血压的发生，但鉴于纳入研究和患者数量有限，上述结论不足以推荐临床使用。
배경：혈액투석요법시치료급성신공능쇠갈적중요수단，기목적가청제과다적수분급독소，유지환자체내적산감평형，위환자용약급영양치료창조조건，동시피면환자출현다장기공능쇠갈。목적：계통평개탄산경염투석액여유산염투석액재급성신공능쇠갈환자혈액투석중적림상료효급응용개치。방법：응용계산궤검색PubMed、EMBASE、SCI、Cochrane Library、중국생물의학문헌수거고、중문과기기간전문수거고、중국기간전문수거고급중화의학회수자화기간，수집탄산경염투석액여유산염투석액재급성신공능쇠갈환자혈액투석중적수궤대조시험，검색시간절지지2014년1월。채용Cochrane계통평개수책문헌질량평개표준평개납입연구질량，용RevMan 5.1연건진행Meta분석。결과여결론：공납입4개수궤대조시험，171례환자。Meta분석결과현시，탄산경염투석액조심혈관병발증、증상성저혈압사건급혈청유산염수평저우유산염투석액조(P<0.05)，량조병사솔、혈청탄산경염수평、혈청기항、pH화pCO2등방면차이무통계학의의。당전증거표명，여유산염투석액상비，탄산경염투석액가강저심혈관병발증，감소증상성저혈압적발생，단감우납입연구화환자수량유한，상술결론불족이추천림상사용。
BACKGROUND:Hemodialysis therapy is an important means for the treatment of acute renal failure, which aims to remove excess water and toxins and maintain acid-base balance of a patient, creating conditions for medication and nutrition therapy while avoiding multiple organ failure. OBJECTIVE:To compare bicarbonate-and lactate-buffered solutions for acute continuous hemodiafiltration in acute renal failure. METHODS:A computer-based search was performed in PubMed, EMBASE, SCI, Cochrane Library, Chinese Biomedical Literature Database, China Journal Ful Text Database, Chinese Medical Association Journals for randomized control trials related to bicarbonate-versus lactate-buffered solutions for hemodiafiltration in acute renal failure published before January 2014. The quality of the included studies was evaluated by Cochrane Handbook, and data were analyzed by RevMan 5.1 from the Cochrane Col aboration. RESULTS AND CONCLUSION:Four studies (171 patients) met inclusion criteria. Overal , patients treated with bicarbonate-buffered solutions had fewer cardiovascular complications and symptomatic hypotension events as wel as lower serum lactate levels than patients who received lactate-buffered solutions (P<0.05). There were no differences in mortality, serum bicarbonate levels, serum creatinine, serum pH, carbon dioxide partial pressure. The current evidence shows that patients undergoing bicarbonate-buffered solutions may experience fewer cardiovascular complications and symptomatic hypotension. Given the limited research, it is insufficient to recommend for clinical use.