限制性液体复苏治疗未控制创伤失血性休克效果的系统评价  

Efficacy in Treatment of Limited Fluid Resuscitation Strategy of Uncontrolled Hemorrhagic Shock: a System Evaluation

作　　者：杨茜[1] 

机构地区：[1]荆州市中心医院ICU,湖北荆州434020

出　　处：《临床误诊误治》2015年第9期101-107,共7页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨限制性液体复苏(limited fluids resuscitation,LFR)治疗未控制性创伤失血性休克(hemorrhagic traumatic shock,HTS)的临床效果。方法以英文关键词"Hemorrhagic Traumatic shock","Uncontrolled","Limited Fluids Resuscitation"及中文关键词"创伤失血性休克"、"未控制性"、"限制性液体复苏"为检索词,检索中英文数据库内1994年1月—2014年1月相关的随机对照试验(RCT)研究,对纳入文献的质量进行严格评价和资料提取,使用Stata/SE version 12.0软件对纳入研究进行系统评价。结果本研究最终纳入RCT文献10篇共1592例,其中试验组796例(予LFR治疗),对照组796例(予常规液体复苏治疗)。系统评价结果显示:与对照组比较,试验组病死率显著下降[P=0.529,I2=0,相对危险度(RR)=0.73,95%可信区间(CI)=(0.56,0.95)],多脏器功能障碍综合征(MODS)发生率显著下降[P=0.895,I2=0,RR=0.54,95%CI=(0.38,0.75)],血红蛋白含量显著升高[标准均数差(SMD)=0.97,95%CI=(0.11,1.84)],但存在显著异质性(P=0、I2=97.2%),且结论偏倚性较大(失安全系统:Nfs0.05=1.08)。结论 LFR策略治疗未控制性HTS,能显著降低患者的病死率及MODS发生率,疗效确切。Objective To investigate the clinical efficacy in patients with limited fluid resuscitation （ LFR） of uncon-trolled Hemorrhagic traumatic shock （HTS）. Methods By searching the RCT during January 1994 and January 2014, strict appraisal and data extraction on the quality of the included studies were carried out, using Stata/SE version 12 software sys-tematic evaluation of included studies. Results 10 articles were eventually included in the study with a total of 1592 cases, including 796 cases in the experimental group （ limited fluid resuscitation） , 796 cases in the control group （ treated with rou-tine fluid resuscitation） . System evaluation results showed that compared to that of conventional fluid resuscitation therapy, mortality rate of patients treated by LFR strategy decreased significantly [P=0. 529, I2 =0, RR=0. 73, 95%CI=（0. 56, 0. 95）];their MODS incidence rate decreased significantly [P=0. 895, I2 =0, RR=0. 54, 95%CI=（0. 38, 0. 75）];and hemoglobin content improved significantly [SMD=0. 97, 95%CI=（0. 11, 1. 84）], but there was significant heterogeneity＆amp;nbsp;（P=0, I2 =97. 2%）, and the conclusion had a larger bias （Nfs0. 05=1. 08）. Conclusion The limited fluid resuscitation strategy of uncontrolled hemorrhagic traumatic shock can significantly reduce the mortality rate and incidence rate of MODS with definite efficacy.

关 键 词：休克 出血性 限制性液体复苏 治疗结果 评价研究 

分 类 号：R605.971[医药卫生—急诊医学]