低压复苏治疗创伤失血性休克的系统评价  

Hypotensive resuscitation for traumatic hemorrhagic shock： a systematic review

作　　者：冯筑生 范颖楠[1] 李俊杰[1] 王倩梅[1] 尹文[1] 

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《中华急诊医学杂志》2016年第5期605-609,共5页Chinese Journal of Emergency Medicine

基　　金：军队重大课题子项目（AWS14C003-01）;陕西省自然科学基础研究计划项目（2014JM4186）

摘　　要：目的系统评价低压复苏治疗创伤失血性休克的有效性。方法计算机检索Pubmed、Embase和The Corchrane Library等数据库，纳入低压复苏治疗创伤失血性休克的随机对照试验或半随机对照试验，检索时间均为从建库至2015年8月。由2位研究者独立进行资料提取和质量评价，采用Rev Man5．3软件进行Meta分析，计数资料使用相对危险度（risk ratio，RR）及其95％可信区间（confidence interval，CI）进行评估，并采用GRADE5．6．1软件对证据质量进行分级。结果纳入4项研究，Meta分析及GRADE评级结果显示：与常规复苏比较，低压复苏有较低的总病死率[RR=0．77，95％CI：0．62～0．95，P=0．01；n=984，GRADE评级：中]及24h病死率[RR=0．47，95％CI：0．24—0．91，P=0．03；n=281，GRADE评级：中]；但总病死率的亚组分析结果显示：在钝挫伤或穿透伤亚组以及穿透伤亚组，两组差异无统计学意义。结论低压复苏能够降低创伤失血性休克患者的总病死率及24h病死率，证据质量为中级。未来研究应该着力于低压复苏对于不同创伤类型患者的疗效进行进一步探索。Objective To systematically review the efficacy of hypotensive resuscitation for traumatic-hemorrhagic shock. Methods Randomized controlled trails （RCTs） or quasi-Randomized controlled trails （qRCTs） were searched in Pubmed, Embase and the Corchrane Library from inception to August 2015. Two reviewers respectively picked out the useful data and performed quality evaluation. Meta- analysis was carried out with RevMan 5.3 software, risk ratio （RR） and its 95% confidence interval （CI） were pooled to estimate the enumeration data, and GRADE 3.6. 1 software was used to rate the level of evidence. Results The results of meta-analysis and GRADE rating system which included 4 studies showed that： compared with conventional resuscitation, hypotensive resuscitation was associated with lower total mortality [RR = 0. 77, 95% CI： O. 62 - 0.95, P = 0.01 ; n = 984, GRADE rating： moderate] , and 24- hour mortality [RR=0.47, 95%CI： 0.24 -0.91, P =0.03; n =281, GRADE rating： moderate] , but the subgroup analysis of total mortality showed that there were no significant differences in mortality between the subgroup of blunt or penetrating trauma and the subgroup of penetrating trauma. Conclusions Hypotensive resuscitation reduced total mortality and 24-hour mortality, and the quality of the evidence was moderate. The future studies should do further research to explore the efficacy of hypotensive resuscitation for different types of trauma.

关 键 词：低压复苏 创伤 休克 系统评价 GRADE系统 

分 类 号：R641[医药卫生—外科学]