血液灌流联合连续性静脉-静脉血液滤过治疗急性百草枯中毒的系统评价与Meta分析  

Systematic review and meta-analysis on hemoperfusion with continuous venovenous hemofiltration for acute paraquat poisoning

作　　者：范颖楠[1] 黄杨[1] 冯筑生 尹文[1] 

机构地区：[1]第四军医大学西京医院急诊科,陕西710032

出　　处：《中国急救复苏与灾害医学杂志》2016年第1期12-16,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家青年科学基金资助项目（81101413）;陕西省自然科学基础基金资助项目（2014JM4186）

摘　　要：目的综合分析血液灌流（hemoperfusion，HP）联合连续性静脉一静脉血液滤过（continuous venovenous hemofihration，CVVH）治疗急性百草枯（paraquat，PQ）中毒的安全性和有效性，为临床治疗PQ中毒提供决策依据。方法计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、万方数据库和维普数据库等数据库中收录的有关HP联合CVVH治疗PQ中毒的相关文献，分别依据Cochrane系统评价手册5．1．0版和Newcastle Ottawa Scale（NOS）量表对随机对照试验（randomized controlled trials，RCTs）和病例对照研究case control studies，CCSs）进行评价，使用ReviewManager5-3统计学软件进行数据的分析和综合，并绘制森林图、漏斗图。结果共纳入3项RCTs，8项CCSs，共计911名患者，其中HP联合CVVH组406例，HP组505例。HP联合CVVH组与HP组相比：①死亡率差异有统计学意义[OR=0．50，95％CI（0．38，0．67），P〈0．01]。②死亡病例存活时间差异有统计学意义【SMD=2．02，95％CI（0．97，3．07），P〈0．01]。结论依据目前的资料，与HP治疗PQ中毒相比，HP联合CVVH能够降低死亡率，延长死亡病例存活时间，但纳入研究可能存在发表偏倚。Objective To analyze the effectiveness and safety of hemoperfusion （HP） with continuous venovenous hemofihration （CVVH） for acute paraquat （PQ） poisoning, which provides evidence for the treatment decisions of PQ poisoning. Methods The data of HP with CVVH for PQ poisoning was collected through searching on PubMed, Embase, the Cochrane Library, CBM, CNKI, Wanfang and VIP database. An evaluation was performed on randomized controlled trials （RCTs） and case control studies （CCSs） with Cochrane handbook 5.1.0 and Newcastle Ottawa Scale （NOS）. The analysis and synthesis of data was conducted by the Review Manager 5.3 statistics software, and drew forest graph and funnel plot. Results 3 RCTs and 8 CCSs were taken in this research which included 911 patients. There were 406 patients in HP with cvVH group and 505 patients in HP group, the results of meta-analysis between HP with CVVH group and HP group were as follows： 1. There was significant difference in mortality （OR=0.50, 95%CI 0.38 to 0.67, P 〈 0.01）;2. There was significant difference in survival time of deaths （SMD =2.02, 95%CI 0.97 to 3.07, P〈0.01）. Conclusion Combining CVVH＇ s effort, HP maybe effective in reducing mortality and prolong survival time for PQ poisoning when comparing with HP alone. However, this study may also indicate publication bias.

关 键 词：百草枯 血液灌注 血液滤过 META分析 

分 类 号：R595.4[医药卫生—内科学]