高容量血液滤过治疗对感染性休克患者预后的荟萃分析  

Effects of high volume hemofiltration on mortality in patients with septic shock： a meta-analysis

作　　者：刘云[1] 谢剑峰[1] 郭凤梅[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院危重病医学科,南京210009

出　　处：《中华医学杂志》2010年第37期2601-2606,共6页National Medical Journal of China

基　　金：江苏省“科教兴卫工程”医学领军人才基金（2007）;江苏省“科教兴卫工程”医学重点人才基金（2007）

摘　　要：目的 评价高容量血液滤过（HVHF）及其治疗时机对感染性休克患者预后的影响.方法 通过计算机检索和手工检索全面收集国内外1999至2009年关于高容量血液滤过治疗感染性休克的随机对照试验（RCT）、病例对照研究及观察性前瞻性队列研究,按Cochrane协作网推荐的方法对HVHF治疗感染性休克的病死率作荟萃评价.结果 纳入4项对照性研究、5项前瞻性队列研究.4项对照性研究（3项RCT、1项病例对照研究）共167例感染性休克患者被纳入,包括HVHF组79例,传统剂量治疗组88例.HVHF组和传统剂量治疗组病死率分别为40.5%（32/79）和72.7%（64/88）,与传统剂量治疗组比较,HVHF能降低感染性休克患者病死率[OR 0.33,（95%CI,0.17～0.64）;P＜0.01].5项前瞻性队列研究共观察了 HVHF对170例感染性休克患者病死率的影响,荟萃分析显示HVHF能降低病死率[OR 0.31,（95%CI,0.19～0.49）;P＜0.01],与对照研究结果一致.仅2项研究探讨了HVHF治疗时机对感染性休克病死率的影响,虽然这两项研究的早期HVHF治疗组病死率均低于晚期HVHF治疗组,但研究的异质性显著（P＜0.05）,不宜作荟萃分析.结论 高容量血液滤过治疗可降低感染性休克患者的病死率,但是受研究方法的限制,有必要进行更多大样本、高质量的随机对照试验.Objective To evaluate the effect of high volume hemofiltration （HVHF） and its therapeutic timing on mortality in patients with septic shock. Methods Randomized controlled trials （RCT）, case-control studies and prospective cohort studies on HVHF treating septic shock patients from 1999 to 2009 were identified by electronic and manually retrieving related data. An Meta-analysis of HVHF on mortality in septic shock patients was conducted through the methods recommended by the Cochrane Collaboration. Results 3 RCTs, 1 case-control study and 5 prospective cohort studies were selected. A total of 167 cases in 4 studies （3 RCTs, 1 case-control study） involving 79 HVHF and 88 LVHF groups were included for a Meta-analysis. The mortalities of septic shock in HVHF and LVHF groups were 40. 5%（32/79） and 72. 7% （64/88） respectively. As compared with traditional LVHF, HVHF could reduce the mortality in patients with septic shock [OR 0. 33, （95% CI,0. 17-0. 64）; P 〈0. 01]. For 170 patients with septic shock in 5 prospective cohort studies, their mortality rates were improved by HVHF [OR 0. 31,（95% CI, 0. 19-0. 49）; P 〈 0. 01]. It was consistent with the results of 4 control studies. Only 2 studies indicated the early HVHF group versus the late HVHF group could improve the survival of septic shock.Since there was significant heterogeneity between them （ P 〈 0. 05 ）, it was better not to perform a Metaanalysis. Conclusion There is a beneficial effect of high volume hemofiltration on mortality in septic shock patients. Further studies of a larger sample of high quality RCTs should be carried out to guide its use.

关 键 词：血液滤过 休克 脓毒性 分析 

分 类 号：R686[医药卫生—骨科学]