急性等容血液稀释血液保护的Meta分析

Meta-analysis of blood conservation of acute normovolemic hemodilution

目的急性等容血液稀释(ANH)血液保护的Meta分析。方法以ANH为关键词检索Medline、EMBase、Cocarane图书馆对照试验注册资料库、中国生物医学数据库、中国医学会议论文数据库,结合检索论文中的参考文献查询相关文献,文献检索至2005年12月。选择成人择期手术中应用ANH的随机对照试验,收集试验组及对照组病人资料进行Meta分析。结果检索到符合条件的文献31篇,包含病例数1582例(试验组/对照组783/799),共纳入32项研究,Jadad’s评分为1分。对纳入研究进行整体分析显示,ANH能减少输血量、输血率,对出血量无影响,输血量、出血量的加权均数差分别为-1．41 u[95%可信区间(95%CI)为-1．82～-1．01u]、-75．43ml(95%CI为-219．46～68．60 ml)(P＜0．05),输血率比数比(OR)为0．14(95%CI为0．07～0．29),各研究间均存在异质性(P＜0．1)。按手术种类、血液稀释程度及有无明确输血指征进行亚组分析结果与整体分析时基本一致。有6项研究报告了并发症情况,不良事件总发生率的OR为0．68(95%CI为0．34～1．36)。结论ANH能减少输血量和输血率,但不减少出血量。

Objective To systematically assess the blood conservation of acute normovolemic hemodilution （ANH） using Meta-analysis. Methods Medline, EMBase, the Cochrane Controlled Trials Register, Chinese Biomedical Database as well as Chinese Medical Academic Conference data were searehed using ANH as the key word up to December 2005. Randomized controlled trails comparing ANH with a control group, conducted during elective operation performed on adults were included. The studies listed at the end of these articles as reference were also searched. Meta-analysis was performed by collecting information based on the available studies. Results The Meta-analysis included 31 trials （containing 32 studies）, a total of 1 582 patients were included （783 in the ANH group and 799 in the control group）. The mean score on the Jadad scale was 1, when all trials were pooled. ANH reduced the volume and rate of allogenic blood transfusion but had no effect on the volume of blood loss. The weighted mean differences （WMD） of the volume of allogeneic blood transfusion and blood loss in the perioperative period were - 1.41 U （95 % confidence interval was - 1.82- - 1.01 U） and - 75.43 ml （95 % CI was - 219.46- 68.60 ml） （ P 〈 0.05）. The odds ratio （OR） of the rate of allogeneic blood transfusion was 0.14 （95% CI was 0.07-0.29）. Among these studies there was a significant heterogencity （P 〈 0.1）. Further subgroup analyses based on the type of surgical procedure, volume of blood withdrawn preoperatively and whether there was an indication for blood transfusion showed that the results were almost the same. There were 6 studies reporting on adverse events. The OR incidence of the complications was 0.68 （95 % CI was 0.34-1.36） . Conclusion ANH reduces the volume and rate of allogeneic blood transfusion but not the volume of blood loss.