血液净化与常规治疗对乳酸酸中毒患者血乳酸清除效果的Meta分析  

Removal of blood lactic acid by blood purification versus by conventional treatment in lactic acidosis patients:a meta analysis

作　　者：黄海燕[1] 张民杰[1] 尹良红[2] 郑兴龙[1] 张百合 HUANG Hai-yan;ZHANG Min-jie;YIN Liang-hong;ZHENG Xing-long;ZHANG Bai-he(Department of Critical Care Medicine,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Nephrology,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Clinical Medicine,College of Science and Technology,Three Gorges University,Yichang 443002,China)

机构地区：[1]暨南大学附属第一医院重症医学科,广州510630 [2]暨南大学附属第一医院肾脏病科,广州510630 [3]三峡大学科技学院临床医学系,宜昌443002

出　　处：《中国血液净化》2021年第1期19-23,共5页Chinese Journal of Blood Purification

基　　金：广东省科技计划项目(2013B090400004);广东省广州市创业领军人才创业启动资金项目(LCX2012153)。

摘　　要：目的系统评价应用血液净化(blood purification,BP)与常规治疗对乳酸酸中毒患者血乳酸的清除效果。方法采用计算机检索Web of Science数据库、PubMed数据库、中国知网(CNKI)、万方数据库、中国生物医学文献光盘数据库(CBMDisc)、维普数据库(VIP)自建库至2020年1月发布的有关血液净化与常规治疗对乳酸酸中毒疗效的随机对照临床试验(randomized controlled trials,RCT)文献;对照组采用常规治疗,实验组在对照组基础上加用血液净化治疗。采用STATA12.0软件进行Meta分析,连续性变量用标准化均数差(SMD)及95%可信区间(95%CI)计算,并绘制漏斗图,评价纳入文献发表偏倚情况。结果文章对纳入的10篇RCT研究进行分析,共563例乳酸酸中毒患者,实验组296例,对照组267例。Meta分析结果显示:与对照组相比,实验组治疗12h、24h及48 h后血乳酸值下降有明显差异(SMD值分别为-1.140,-2.060,-2.600;95%CI分别为-2.150~-0.130,-3.090~-1.020,-4.000~-1.190,P值分别为0.027,<0.001,<0.001)。结论血液净化与常规治疗均能有效清除乳酸酸中毒患者体内血乳酸,但血液净化治疗方法疗效更显著,值得临床推广应用。Objective To systematically review the removal effect of blood lactic acid by blood purification(BP)versus by conventional treatment in the patients with lactic acidosis.Methods The databases of Web of science,PubMed,CNKI,WanFang,VIP and CBMDisc were retrieved from the establishment of the database to January 2020 for the randomized controlled trials of lactic acidosis treatment by BP and conventional methods.The control group used conventional treatment,and the trial group used BP on the basis of conventional treatment.The software of STATA12.0 was used for meta analysis.The continuous variables were expressed as SMD and 95%CI.Funnel plot was used to evaluate the publication bias.Results There were totally 10 randomized controlled trials including 296 cases in trial group and 267 cases in control group.Meta-analysis showed that the reduction of lactate levels after the treatment for 12,24 and 48 hours were more in trial group than in control group,and the differences were significant(12 h:SMD=-1.14,95%CI=-2.15~-0.13,P=0.027;24 h:SMD=-2.06,95%CI=-3.09~-1.02,P=0.000;48 h:SMD=-2.60,95%CI=-4.00~-1.19,P=0.000).Conclusion Both BP and conventional treatment removed blood lactic acid effectively in lactic acidosis patients,but the curative effect using BP was better.These results have therapeutic implications in clinical practice.

关 键 词：血液净化 乳酸酸中毒 血乳酸 META分析 

分 类 号：R318.16[医药卫生—生物医学工程]