摘要
目的系统评价连续性肾脏替代治疗(CRRT)联合乌司他丁对严重脓毒症患者的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、中国万方数据库及维普中文科技期刊数据库建库至2020年1月期间有关以CRRT联合乌司他丁治疗严重脓毒症患者的随机对照试验(RCT)。由2位研究员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Review Manager 5.3软件进行Meta分析。结果最终纳入24项RCT,共计1636例脓毒症患者,其中试验组(CRRT联合乌司他丁)823例患者,对照组(单用CRRT)813例患者。Meta分析结果显示,与对照组比较,试验组患者病死率[相对危险度=0.39,95%置信区间(CI)(0.31,0.50),Z=7.65,P<0.00001]及急性病生理学和长期健康评价Ⅱ评分[均数差(MD)=-3.53,95%CI(-3.96,-3.10),Z=16.04,P<0.00001]均显著降低,机械通气时间[MD=-2.76,95%CI(-4.57,-0.96),Z=3.00,P=0.003]明显缩短,肿瘤坏死因子α[标准化均数差(SMD)=-1.75,95%CI(-2.75,-0.76),Z=3.44,P=0.0006]、白细胞介素6[SMD=-2.29,95%CI(-2.90,-1.67),Z=7.32,P<0.00001]、白细胞介素8[SMD=-1.77,95%CI(-2.43,-1.10),Z=5.21,P<0.00001]、降钙素原[MD=-2.63,95%CI(-3.66,-1.60),Z=5.01,P<0.00001]、C反应蛋白[MD=-15.80,95%CI(-19.45,-12.15),Z=8.48,P<0.00001]、D-二聚体[MD=-1.48,95%CI(-1.54,-1.41),Z=44.38,P<0.00001]、凝血酶原时间[MD=-3.49,95%CI(-5.32,-1.65),Z=3.72,P=0.0002]及活化部分凝血活酶时间[MD=-5.28,95%CI(-7.79,-2.76),Z=4.11,P<0.0001]水平均显著下降。而两组脓毒症患者间抗生素使用时间[MD=-0.19,95%CI(-0.79,0.42),Z=0.61,P=0.54]及血小板计数[MD=34.71,95%CI(-15.51,84.93),Z=1.35,P=0.18]的比较,差异均无统计学意义。结论相比与单用CRRT,CRRT联合乌司他丁治疗严重脓毒症更有效。
Objective To systematically evaluate the clinical efficacy of continuous renal replacement therapy(CRRT)combined with ulinastatin in patients with severe sepsis.Methods The randomized controlled trials(RCTs)on patients with severe sepsis treated by CRRT combined with ulinastatin were searched from PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang and VIP databases published up to January 2020.Two reviewers independentlyscreened articles and extracted data according to inclusion and exclusion criteria,and evaluated the quality of included studies.Then meta-analysis was conducted using Review Manager 5.3 software.Results A total of 24 RCTs involving 1636 patients were included in this study,with 823 patients in the experimental group(CRRT combined with ulinastatin)and 813 patients in the control group(CRRT alone).Meta-analysis showed that as compared with the control group,the mortality[relative risk=0.39,95%confidence interval(CI)(0.31,0.50),Z=7.65,P<0.00001]and acute physiology and chronic health evaluationⅡ[mean differences(MD)=-3.53,95%CI(-3.96,-3.10),Z=16.04,P<0.00001]were lower,the mechanical ventilation time[MD=-2.76,95%CI(-4.57,-0.96),Z=3.00,P=0.003]was shorter,the levels of tumor necrosis factor-alpha[standardized mean difference(SMD)=-1.75,95%CI(-2.75,-0.76),Z=3.44,P=0.0006],interleukin-6[SMD=-2.29,95%CI(-2.90,-1.67),Z=7.32,P<0.00001],interleukin-8[SMD=-1.77,95%CI(-2.43,-1.10),Z=5.21,P<0.00001],procalcitonin[MD=-2.63,95%CI(-3.66,-1.60),Z=5.01,P<0.00001],C-reactive protein[MD=-15.80,95%CI(-19.45,-12.15),Z=8.48,P<0.00001],D-dimer[MD=-1.48,95%CI(-1.54,-1.41),Z=44.38,P<0.00001],prothrombin time[MD=-3.49,95%CI(-5.32,-1.65),Z=3.72,P=0.0002]and activated partial thomboplastin time[MD=-5.28,95%CI(-7.79,-2.76),Z=4.11,P<0.0001]were decreased in the experimental group.However,the duration of antibiotic use[MD=-0.19,95%CI(-0.79,0.42),Z=0.61,P=0.54]and platelet count[MD=34.71,95%CI(-15.51,84.93),Z=1.35,P=0.18]were not significantly different between the two groups.Conclusion CRRT combined with ulinastatin is more effective in treating patients with severe sepsis than CRRT alone.
作者
王育凯
陈军贤
施小伟
吴本权
Wang Yukai;Chen Junxian;Shi Xiaowei;Wu Benquan(Department of Medical Intensive Care Unit,Department of Pulmonary and Critical Care Medicine,Institute of Respiratory Diseases of Sun Yat-Sen University,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2021年第4期297-307,共11页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
广东省科技发展专项资金项目(2017A020215177)。
