平衡盐液和生理盐水对重症患者综合效果的Meta分析  

Comprehensive effect of balanced crystalloids or saline in critically ill patients: a Meta-analysis

作　　者：龚菊 黄晓文[2] 张碧波 李斌[1] 张凌 Gong Ju;Huang Xiao-wen;Zhang Bi-bo;Li Bin;Zhang Ling(Department of Critical Care Medicine, Changshu Second People′s Hospital Affiliated to Yangzhou University, Changshu 215500, China)

机构地区：[1]扬州大学第五临床医学院常熟市第二人民医院重症医学科,江苏常熟215500 [2]南京中医药大学附属常熟市中医院推拿科,江苏常熟215500 [3]扬州大学第五临床医学院常熟市第二人民医院心内科,江苏常熟215500

出　　处：《中国急救医学》2019年第2期156-160,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的采用Meta分析比较平衡盐液和生理盐水对重症患者的综合效果。方法应用计算机检索美国国立医学图书馆PubMed数据库、Cochrane数据库、万方数据库、中国知网,收集比较平衡盐液和生理盐水综合效果的随机对照临床试验(RCT)。研究对象为重症患者,检索时限为建库至2018年4月。由2名评价者按照纳入与排除标准选择文献、提取资料和评价质量后,采用RevMan5.3软件进行Meta分析。结果初筛共获得160篇文献,剔除重复文献及不符合纳入标准文献后,共纳入4项研究19105例患者,平衡盐液组9647例,生理盐水组9458例。Meta分析显示,两组患者ICU病死率比较差异无统计学意义(RR0.91,95%CI0.82~1.01,P=0.09);肾脏替代治疗(RRT)使用率比较差异无统计学意义(RR1.03,95%CI0.61~1.75,P=0.91);急性肾损伤(AKI)2级及以上发生率比较差异无统计学意义(RR0.93,95%CI0.85~1.01,P=0.07);住院30d病死率(RR0.93,95%CI0.85~1.01,P=0.08)、住院60d病死率(RR0.94,95%CI0.87~1.02,P=0.13)比较差异无统计学意义。漏斗图分析结果显示,未见发表偏倚。结论与生理盐水比较,重症患者应用平衡盐液,不能降低住院病死率、RRT使用率、AKI2级及以上发生率。Objective To systematically evaluate the comprehensive effect of balanced crystalloids or saline in critically ill patients.Methods The randomized controlled clinical trials (RCT)comparing balanced crystalloids or saline in critically ill patients were collected through the databases such as the PubMed database of the National Library of Medicine,Cochrane Library,CNKI, Wanfang database.The subjects were critically ill patients,and the retrieval time ranged from January ,1966 to April 2018.Two reviewers independently screened the studies according to the inclusive and exclusive criteria,extracted the data,and assessed the quality.Then RevMan 5.3 software was used for Meta -analysis.Results In the 160 documents obtained from preliminary screening,a total of 4 studies involving 19 105 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria,with 9647 patients in balanced crystalloids group,and 9458,in saline group. Meta-analysis showed that there was no significant difference in ICU mortality rate between the two groups (RR 0.91,95%CI 0.82-1.01,P =0.09),no statistical difference was found in the rate of RRT therapy (RR 1.03,95%CI 0.61 ~1.75,P =0.91 ),no statistical difference was found in the rate of AKI stage II or greater (RR 0.93,95%CI 0.85 ~1.01,P =0.07 ),no statistical difference was found in the hospital mortality before 30 days (RR 0.93,95%CI 0.85 -1.01,P =0.08 )or 60 days (RR0.94,95%CI 0.87 -1.02,P =0.13).Conclusion In critically ill patients,compared with saline, balanced crystalloids couldn't decrease the ICU mortality,rate of RRT therapy,rate of AKI stage Ⅱ or greater.

关 键 词：平衡液 氯化钠 危重患者医疗 META分析 

分 类 号：R459.7[医药卫生—急诊医学]