局部枸橼酸钠与普通肝素在连续性肾脏替代疗法中抗凝疗效的Meta分析  

Meta-analysis of the Anticoagulant Efficacy of Local Sodium Citrate and Unfractionated Heparin in Continuous Renal Replacement Therapy

作　　者：李依桥 胡芳 LI Yi-qiao;HU Fang(Department of Inner Medicine,Section Two,the Second People's Hospital of Taoyuan County,Changde,Hunan Province 415701 China;Department of Imaging,Tongliang District People's Hospital,Tongliang,Chongqing,402560 China)

机构地区：[1]桃源县第二人民医院内二科,湖南常德415701 [2]铜梁区人民医院影像科,重庆铜梁402560

出　　处：《中外医疗》2020年第20期34-37,52,共5页China & Foreign Medical Treatment

摘　　要：目的评价局部枸橼酸抗凝在CRRT治疗中的疗效和安全性。方法检索PubMed、EMBASE、Cochrane图书馆、中国知网CNKI、CBM、万方。方法收集随机对照试验数据,比较局部枸橼酸抗凝和肝素抗凝在连续性肾脏替代治疗中的抗凝疗效。检索日期截止于2019年3月。根据纳入和排除标准,选择合适的研究实验文献,进行质量评价,提取有效数据进行Meta分析。结果共纳入7个随机对照试验,共包括618例患者。统计学方法采用Review Manager5.3软件进行Meta分析。分析显示:在连续性血液净化中,枸橼酸钠局部抗凝有效地延长了滤器寿命[MD=7.99,95%CI(6.37,961),P<0.00001],减少出血事件发生概率[OR=0.26,95%CI(0.14,0.47),P<0.00001],低血钙事件发生率差异无统计学意义[OR=2.99,95%CI(1.00,8.92),P=0.05],局部枸橼酸钠与肝素抗凝对透析后APTT值的影响差异无统计学意义[MD=-4.05,95%CI(-8.19,0.10),P=0.06]。结论根据所收集的临床资料,枸橼酸钠局部抗凝可延长过滤器在连续血液净化治疗中的使用寿命,减少了出血事件的发生率。它更适合出血风险高的患者,但需重视其钙离子代谢紊乱风险。Objective To evaluate the efficacy and safety of local citrate anticoagulation in CRRT treatment.Methods Search PubMed,EMBASE,Cochrane Library,CNKI,CBM,Wanfang.Collect randomized controlled trial data to compare the anticoagulant efficacy of local citrate anticoagulation and heparin anticoagulation in continuous renal replacement therapy.The search date ends in March 2019.According to the inclusion and exclusion criteria,select appropriate research literature,conduct quality evaluation,and extract valid data for meta-analysis.Results A total of 7 randomized controlled trials were included,including a total of 618 patients.The statistical method used Review Manager 5.3 software for Meta analysis.Analysis shows that in continuous blood purification,sodium citrate local anticoagulation effectively prolongs the life of the filter[MD=7.99,95%CI(6.37,961),P<0.00001],reducing the probability of bleeding events[OR=0.26,95%CI(0.14,0.47),P<0.00001],the incidence of hypocalcemia events,the difference was statistically significant[OR=2.99,95%CI(1.00,8.92),P=0.05],There is no statistically significant difference in the effect of local sodium citrate and heparin anticoagulation on the APTT value after dialysis[MD=-4.05,95%CI(-8.19,0.10),P=0.06].Conclusion According to the collected clinical data,sodium citrate local anticoagulation can prolong the service life of the filter in continuous blood purification treatment and reduce the incidence of bleeding events.It is more suitable for patients with high bleeding risk,but it needs to pay attention to the risk of calcium ion metabolism disorder.

关 键 词：枸橼酸钠 肝素 连续性肾脏替代治疗 META分析 

分 类 号：R459.5[医药卫生—治疗学]