血液超滤与利尿剂对充血性心力衰竭的疗效比较——Meta分析  

The effect of ultrafiltration and diuretic therapy on decompensated heart failure: a meta-analysis

作　　者：费宇行[1] 张蓉[1] 邢娜[2] 李晶 赵力[1] 裘毅刚[1] 李明旭[4] FEI Yu-xing ZHANG Rong XING Na LI Jing ZHAO Li QIU Yi-gang LI Ming-xu(Navy General Hospital of PLA, Beijing 100048, China)

机构地区：[1]海军总医院心血管内科,北京100048 [2]海军总医院信息科,北京100048 [3]海军总医院干部病房,北京100048 [4]海军总医院肾脏病科,北京100048

出　　处：《中国血液净化》2017年第7期463-468,共6页Chinese Journal of Blood Purification

摘　　要：目的系统评价血液超滤与利尿剂在充血性心力衰竭中治疗效果。方法通过Pub med、中国生物医学文献等数据库,检索2016年11月前发表的超滤与利尿剂治疗心力衰竭的随机对照研究,制定纳入和排除标准,经文献审核、质量评估和数据提取,应用Rev Man软件分析。结果共计纳入11项研究。病例总数870例,超滤组434例,对照组436例;与对照组比较,超滤组患者体质量降低更为显著[加权均数差(WMD)=1.390,95%可信区间(95% CI)0.640~2.150,P<0.001]、体液清除量明显增加(WMD=1.220,95% CI 0.490~1.960,P=0.001);与心力衰竭相关的再住院率减少[比值比(OR)=0.600,95% CI-0.430~0.840,P=0.003];2种治疗方法在血肌酐(WMD=0,95% CI-0.250~0.250,P=0.980)、左室射血分数(WMD=-0.020,95% CI-0.070~0.020,P=0.280)、氨基末端脑钠肽前体(WMD=2327.610,95% CI-5215.360~560.130,P=0.110)水平及死亡率(OR=0.990,95% CI 0.660~1.470,P=0.960)无明显差别。未出现与治疗方法相关危及生命的并发症。结论超滤在充血性心力衰竭治疗中减轻容量负荷作用较利尿剂更为明显,可以减少再住院率,对死亡率无明显影响。是一种安全、有效的治疗方法。Objective To evaluate the effect of ultrafiltration （UF） and intravenous diuretics on patients with congestive heart failure. Methods PubMed, CBM and other databases were searched from inception to Nov. 2016 for randomized controlled trials that used diuretics as control group. Inclusion and exclusion criteria were defined. After quality assessment and data extraction the records were analyzed with Rev Man 5.3 software for mete-analysis. Results Eleven studies including 870 cases （n=434 in UF group, n=436 in diuretics group） were enrolled in this study. UF therapy led to greater weight loss （WMD=1.390, 95% CI 0.640-2.150, P 〈0.001）, more fluid remove （WMD=l.220, 95% CI 0.490- 1.960, P=0.001）, and less rehos- pitalization rate （OR=0.600, 95% CI：0.430-0.840, P=0.003） as compared with the patients in diuretic group. However, there were no significant differences in mortality （OR=0.990, 95% C1 0.660- 1.470, P=0.960）, creatinine （WMD=0, 95% CI-0.250-0.250, P=0.980）, LVEF （WMD=-0.020, 95% C1-0.070-0.020, P=0.280） and NT-ProBNP （WMD=2327.610, 95% CI-5215.360-560.130, P=0.110） between the two groups. No serious adverse events were reported in the two groups. Conclusion UF is more efficient and safer than diuretics for heart failure patients with fluid overload. Heart failure related rehospitalization rate was lower after UF. However, survival was similar between patients treated with UF and those with diuretics. Serious adverse events were not found in UF patients.

关 键 词：充血性心力衰竭 超滤 利尿剂 META分析 

分 类 号：R459.5[医药卫生—治疗学]