摘要
目的评估血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)对急性百草枯(PQ)中毒的疗效。方法检索PubMed、Embase、Cochrane Library、Web of Science、SinoMed、中国知网和万方等数据库中有关HP联合CVVH对口服PQ急性中毒(中毒时间≤24 h)患者疗效的前瞻性随机对照试验和回顾性对照研究,检索时限为建库至2019年11月1日。试验组采用HP+CVVH治疗,对照组采用HP治疗。提取文献一般信息及患者病死率、存活时间、呼吸衰竭和循环衰竭发生率等数据。采用RevMan 5.3软件进行文献风险评估和Meta分析。结果共检索1041篇文献,最终纳入7篇、共1199例患者,其中对照组735例,试验组464例。Meta分析结果显示:与单纯HP治疗相比,HP+CVVH治疗可明显降低患者短期病死率〔4 d病死率:风险比(HR)=0.52,95%可信区间(95%CI)为0.38~0.71,P<0.0001〕,但对远期病死率无明显改善(28 d或30 d病死率:HR=0.68,95%CI为0.39~1.21,P=0.19;90 d病死率:HR=1.13,95%CI为0.61~2.10,P=0.70;总病死率:HR=0.96,95%CI为0.72~1.29,P=0.78)。经HP+CVVH治疗后患者存活时间显著长于单纯HP治疗者〔均数差(MD)=2.02,95%CI为0.81~3.22,P=0.001〕,但各研究间异质性较大;根据文献类型进行亚组分析显示,无论是前瞻性研究还是回顾性研究,HP+CVVH治疗均可显著延长患者的存活时间(前瞻性研究:MD=1.53,95%CI为0.94~2.12,P<0.00001;回顾性研究:MD=2.40,95%CI为0.08~4.73,P=0.04)。与HP治疗相比,HP+CVVH治疗后可显著降低患者循环衰竭发生率〔相对危险度(RR)=0.40,95%CI为0.30~0.52,P<0.00001〕,但呼吸衰竭发生率却显著升高(RR=2.75,95%CI为2.18~3.48,P<0.00001)。结论HP联合CVVH可降低PQ中毒患者短期病死率和循环衰竭发生率,延长患者存活时间,为进一步抢救赢取时间,但并不能改善患者远期预后。
Objective To evaluate the efficacy of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)on the treatment of acute paraquat(PQ)poisoning.Methods Prospective randomized controlled trials and retrospective studies on the efficacy of HP combined CVVH in patients with oral PQ poisoning(poisoning time≤24 hours)were found by searching from PubMed,Embase,Cochrane Library,Web of Science,SinoMed,CNKI and Wanfang databases before November 1st,2019.The experimental group was treated with HP+CVVH,and the control group was treated with HP.Data included the general information of the literature,mortality,survival time,the incidence of respiratory failure and circulatory failure.The bias risk and the data were analyzed using the RevMan 5.3 software.Results A total of 1041 literatures were retrieved,and 7 literatures were finally enrolled,including 1199 patients,with 735 patients in the control group and 464 patients in experimental group.Meta-analysis showed that compared with HP alone,HP+CVVH could significantly reduce the short-term mortality[4-day mortality:hazard ratio(HR)=0.52,95%confidence interval(95%CI)was 0.38-0.71,P<0.0001],but no significant improvement in long-term mortality was found(28-day or 30-day mortality:HR=0.68,95%CI was 0.39-1.21,P=0.19;90-day mortality:HR=1.13,95%CI was 0.61-2.10,P=0.07;total mortality:HR=0.96,95%CI was 0.72-1.29,P=0.78).The survival time of patients treated with HP+CVVH was significantly longer than that of HP patients[mean difference(MD)=2.02,95%CI was 0.81-3.22,P=0.001],but the heterogeneity between studies was large.According to the type of literature,a subgroup analysis showed that the survival time of patients treated with HP+CVVH in prospective randomized controlled trials and retrospective studies were significantly longer than that of HP patients(prospective studies:MD=1.53,95%CI was 0.94-2.12,P<0.00001;retrospective studies:MD=2.40,95%CI was 0.08-4.73,P=0.04).Compared with HP group,HP+CVVH could significantly reduce the incidence of circulatory failure[relative risk(RR)=0.40,95%CI was 0.30-0.52,P<0.00001],but the incidence of respiratory failure significantly increased(RR=2.75,95%CI was 2.18-3.48,P<0.00001).Conclusion HP combined with CVVH can reduce the short-term mortality and the incidence of circulatory failure,prolong the survival time,and save time for further rescue,but it can't improve the long-term prognosis of patients.
作者
孙艺青
樊占宏
郑拓康
孟兆华
苑霖
田英平
Sun Yiqing;Fan Zhanhong;Zheng Tuokang;Meng Zhaohua;Yuan Lin;Tian Yingping(Department of Emergency Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第6期726-731,共6页
Chinese Critical Care Medicine
基金
卫生应急准备和处置关键技术研究与推广中毒应急处置关键技术研究与推广项目(201202006-06)。
