75g/L氯化钠溶液对创伤失血性休克液体复苏临床疗效的Meta分析  

Clinical efficacy of fluid resuscitation with 75 g/L NaCI solution in traumatic hypovolemic shock ：a Meta-analysis of randomized controlled trials

作　　者：汪伟[1] 谭佳颖[1] 赵锋[1] 曹隽[1] 王小钦 曹同瓦[1] 祝禾辰[1] 

机构地区：[1]复旦大学附属华山医院ICU,上海200040 [2]临床流行病学／循证医学中心

出　　处：《中华创伤杂志》2012年第4期305-311,共7页Chinese Journal of Trauma

摘　　要：目的以Meta分析方法研究75g/L氯化钠（NaC1）溶液对创伤后失血性休克液体复苏的临床疗效。方法检索PUBMED、EMBASE、OVID、Cochrane图书馆、EBSCO数据库，根据制定的入选标准筛选随机对照试验（randomizedcontrolledtrial，RCT），并进行文献质量评价。对选定的RCT提取和分析患者的血压、血红蛋白、血钠和病死率等指标，以等渗晶体液为参照评价75g/L氯化钠溶液的有效性和安全性。采用ReviewManager5．0．25分析提取的相关数据。结果共有6篇RCT符合入选标准。分析表明775g/L氯化钠溶液相对于等渗晶体液可以早期、快速提升血压（标准差=6．23，95％CI2．78-9．69，P〈0．01），同时可以造成血红蛋白含量的下降（标准差=-6．11，95％CI-8．25--3．96，P〈0．01）；75g／L氯化钠溶液产生的短期高渗状态总体上是有效和安全的（标准差=7．97，95％CI7．55-8．38，P〈0．01）；75g／L氯化钠溶液组与等渗晶体液组比较，创伤失血性休克患者的住院病死率差异无统计学意义（风险率=0．96，95％C10．84-1．10，P〉0．05）。结论创伤后失血性休克液体复苏中使用小容量75g／L氯化钠溶液是安全和有效的。Objective To investigate the efficacy and safety of fluid resuscitation with 75 g/L NaC1 solution in traumatic hypovolemic shock using Meta-analysis. Methods Based on the inclusion criteria, the randomized controlled trials （RCTs） were identified by retrieving the databases including PUBMED, EMBASE, OVID, Cochrane library and EBSCO. The quality of studies was also evaluated. Indices including systolic blood pressure, hemoglobin, serum Na level and mortality were extracted from the enrolled RTCs and were comparatively analyzed between the 75 g/L NaC1 group and the isotonic saline group for evaluating the safety and efficacy of 75 g/L NaC1 solution. The extracted data were analyzed by using the Review Manager 5.0.25. Results Six RCTs were eligible for Meta-analysis. The 75 g/L NaC1 group displayed remarkable increase in systolic blood pressure and decrease in hemoglobin level, compared with the isotonic saline group （ MD -6.23, 95% CI 2.78-9.69, P 〈 0.01 ; MD = -6.11, 95% CI -8.25-3.96, P 〈 0.01, respectively）. Short-term hyperosmolar state in 75 g/L NaC1 group was in- creased significantly but was considered acceptable （ MD = 7.97, 95% CI 7.55-8.38, P 〈 0.01 ）. No significant difference in mortality was found between 75 g/L NaC1 group and isotonic saline group （ RR = 0.96, 95% CI 0.84-1.10, P 〉 0.05 ）. Conclusion Fluid resuscitation with 75 g/L NaC1 solution is safe and effective for traumatic hypovolemic shock.

关 键 词：休克 出血性 复苏术 META分析 盐水 高渗 

分 类 号：R641[医药卫生—外科学]