超声指导脓毒性休克患者液体复苏疗效的Meta分析和试验序贯分析  

Efficacy of ultrasound in fluid resuscitation for the patients with septic shock:a meta-analysis and trial sequential analysis

作　　者：周承 张元华[1] 姚易兰 Zhou Cheng;Zhang Yuan-hua;Yao Yi-lan(Intensive Care Unit,the First People's Hospital of Yibin,644000 Yibin,China)

机构地区：[1]宜宾市第一人民医院重症监护室,四川宜宾644000 [2]宜宾市第一人民医院超声科,四川宜宾644000

出　　处：《中国急救医学》2020年第9期847-852,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的评估超声在脓毒性休克患者液体复苏中的疗效.方法计算机检索PubMed、Embase、Cochrane图书馆等数据库,收集超声(超声组)对比PiCCO(PiCCO组)监测脓毒性休克患者效果的随机对照试验(RCT).采用Rev Man 5.2统计软件进行Meta分析,TSAv 0.9软件进行试验序贯分析(TSA).结果共纳入12项RCT,合计772例患者.超声组6 h复苏达标人数明显高于PiCCO组.同时,超声组CRRT人数、6 h液体复苏量和ICU入住时间均明显少于PiCCO组.两组28 d病死率差异无统计学意义,但TSA分析表明目前的样本量尚不足以判断两种监测方式对患者28 d病死率的影响.结论超声可以有效指导脓毒性休克患者液体复苏,但对28 d病死率的影响还需更多的高质量研究来证明.Objective To assess the efficacy of ultrasound in fluid resuscitation for the patients with septic shock.Methods The randomized controlled clinical trials(RCT)of ultrasound versus PiCCO in the treatment of septic shock patients were collected according to the databases such as the PubMed,Embase,Cochrane Library.Rev Man 5.2 software was used for the meta-analysis.TSAv 0.9 software was used for trial sequential analysis(TSA).Results A total of 12 RCTs included 772 patients.The number of patients reaching the standard in ultrasound group after 6-hour resuscitation was significantly higher than those in PiCCO group.At the same time,the number of CRRT needed,the fluid volume within 6 hours and the ICU occupancy time in ultrasound group were less than those in PiCCO group.Although there was no statistical significance in the 28-day mortality between the two groups,the results of TSA showed that the sample size was not enough to judge the effect of two monitoring modes on the patients'28-day mortality.Conclusion Ultrasound is effective in the guidance of the fluid resuscitation for the patients with septic shock,while its impact on 28-day mortality requires further confirmation by more studies with high quality.

关 键 词：超声 脓毒性休克 随机对照研究 Meta分析 试验序贯分析(TSA) 

分 类 号：R459.7[医药卫生—急诊医学]