肝素治疗脓毒症的系统评价  

Heparin for treatment of sepsis： a systemic review

作　　者：刘志永[1] 朱红[2] 马晓春[1] 

机构地区：[1]中国医科大学附属第一医院重症医学科,辽宁沈阳110001 [2]中国医科大学附属第一医院皮肤性病科,辽宁沈阳110001

出　　处：《中华危重病急救医学》2014年第3期135-141,共7页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81201484）;国家自然科学基金（81101411）;辽宁省博士启动基金（20111102）;辽宁省医学高峰建设工程项目（2010-1067）

摘　　要：目的 系统评价肝素治疗脓毒症患者的有效性及安全性.方法 通过计算机检索IM/MEDLINE、Cochrane Library、SCIE、CBM、中国知网CNKI、维普数据库、万方数据库,纳入肝素治疗脓毒症的随机对照临床试验（RCT）.检索时限为2000年1月至2012年6月.按照纳入标准及排除标准筛选文献、提取数据和质量评价,采用RevMan 5.1软件进行荟萃分析（Meta分析）.结果 共纳入17个RCT研究、1 167例脓毒症患者.Meta分析结果显示：与对照组相比,肝素能显著降低脓毒症患者28 d病死率[比值比（OR）=0.59,95％可信区间（95％CI）为0.45～ 0.77,P=0.000 1]；肝素并未导致凝血功能紊乱恶化,相反能够纠正脓毒症所致血小板计数（PLT）的降低[均数差（MD）=13.94,95％CI为10.15～17.72,P＜0.000 01],同时对活化部分凝血活酶时间（APTT）及凝血酶原时间（PT）均无明显影响（APTT：MD=-3.18,95％CI为-6.88 ～ 0.53,P=0.09;PT：MD=-0.68,95％CI为-1.48 ～0.12,P=0.09）；在出血发生率方面两组亦无明显差异.肝素组治疗后急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分明显低于对照组（MD=-2.58,95％CI为-3.29 ～-1.87,P＜0.000 01）,多器官功能障碍综合征（MODS）发生率明显低于对照组（OR=0.32,95％CI为0.17 ～0.61,P=0.000 6）.另外,肝素能明显缩短脓毒症患者的重症监护病房（ICU）住院时间（MD=-4.43,95％ CI为-6.79 ～-2.07,P=0.000 2）,而对总住院时间无明显影响.结论 肝素能改善脓毒症患者病情严重程度,降低病死率,且安全性及经济性较高.受纳入研究质量限制,所得结论尚需开展大样本、设计严格的RCT研究验证.Objective To systemically review the efficacy and safety of heparin for treatment of sepsis. Methods Database search of IM/MEDLINE, Coehrane Library, SCIE, CBM, CNKI, VIP Data, WanFang Data （from January 2000 to June 2012 ） was conducted. The quality of included randomized controlled trials （RCTs） about heparin for treatment of sepsis was assessed, and relevant data were extracted according to the inclusion and exclusion criteria. Then meta analysis was performed using RevMan 5.1. Results 17 trials with 1 167 participants were included. The results of meta-analysis showed： compared with the control group, heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio （OR） =0.59, 95% confidence interval （95%CI） 0.45-0.77, P=0.0001 ] ; heparin did not deteriorate coagulation disorders, but corrected sepsis-induced platelet （PLT） count reduction （mean difference （MD） =13.94, 95% CI 10.15 to 17.72, P〈0.000 01], while it had no significant effect on the activated partial thromboplastin time （APTT） and prothrombin time （PT, APTT： MD：-3.18, 95%CI -6.88 to 0.53, P：0.09; PT： MD=-0.68, 95%CI -1.48 to 0.12, P=0.09）. There was no significant difference between the two groups in the incidence of bleeding either. Acute physiology and chronic health evaluation II （APACHE II ） score of heparin group was significantly lower than that of the control group （MD=-2.58, 95%CI-3.29 to -1.87, P〈0.000 01）, and the incidence of multiple organ dysfunction syndrome （MODS） was significantly lower than that of the control group （OR = 0.32, 95%CI 0.17 to 0.61, P=0.000 6）. In addition, heparin could shorten intensive care unit （ICU） stay （MD=-4.43, 95%CI -6.79 to -2.07, P=0.000 2）, whereas it showed no significant effect on the total length of hospital stay. Conclusions Heparin can ameliorate sepsis, and has high degree of safety and lower hospital expense. Due to limitation of the quality of included studies, larger sample and well-designed RCTs are n

关 键 词：肝素 脓毒症 随机对照临床试验 系统评价 META分析 

分 类 号：R459.7[医药卫生—急诊医学]