胶体液与晶体液对感染性休克患者液体复苏影响的Meta分析

Colloids vs.crystalloids in fluid resuscitation for septic shock： a Meta-analysis

目的 系统评价使用胶体液与晶体液对感染性休克患者液体复苏的影响.方法 通过检索MEDLINE、荷兰医学文摘（Embase）、Cochrane临床试验数据库、中国生物医学文献数据库（CBM）和中国期刊网全文数据库（CNKI）等数据库,收集胶体液与晶体液治疗成年感染性休克患者的随机对照试验（RCT）,提取资料和评估方法学质量,采用Cochrane协作网RevMan 5.0软件进行Meta分析.结果 最终纳入9个RCT共1998例感染性休克患者.Meta分析显示,胶体液与晶体液复苏对感染性休克患者28d病死率、平均动脉压（MAP）和心率（HR）的影响差异无统计学意义,其中28d病死率的相对危险度（RR）为0.92,95%可信区间（CI）为0.80～1.05,P=0.21;MAP标准化均数差值（SMD）为1.04,95%CI为-0.44～2.51,P=0.17;HR的SMD为0.51,95%CI为-5.84～6.86,P=0.87.胶体液可以明显提高感染性休克患者的心排血指数（CI）,SMD为0.39,95%CI为0.17～0.62,P=0.000 5;进一步亚组分析表明,人血白蛋白可以明显提高感染性休克患者的CI,SMD为0.46,95%CI为0.16～0.75,P=0.002,而人工胶体液无此作用（P=0.07）.结论 胶体液可以明显提高感染性休克患者的CI,但对感染性休克患者28 d病死率、MAP、HR无显著影响.

Abstract：Objective To systematically review the effects of colloids compared with crystalloids in fluid resuscitation for septic shock.Methods The PubMed, Embase, Cochrane Library, CBM and CNKI were searched.All randomized controlled trials （RCTs） of adult patients requiring fluid resuscitation comparing colloids vs.crystalloids were retrieved.Study selection and assessment, data collection and analyses were undertaken.Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software.Results Nine RCTs, involving a total of 1998 patients were included in the review.No differences were found between colloid and crystalloid resuscitation with respect to 28-day mortality [relative risk （RR） was 0.92, 95% confidence interval （95%CI） was 0.80-1.05, P=0.21], mean arterial pressure [MAP,standardized mean difference （SMD） was 1.04, 95%CI was-0.44-2.51, P=0.17] and heart rate （HR,SMD was 0.51, 95%CI was -5.84 - 6.86, P=0.87）.But a significant difference was observed in cardiac index （Cf, SMD was 0.39, 95%CI was 0.17 - 0.62, P=0.0005） between two groups.Subgroup analysis suggested a statistically significant difference in CI when albumin was used in resuscitation （SMD was 0.46,95%CI was 0.16 - 0.75, P=0.002）.But synthetic colloids did not have such effect （P=0.07）.Conclusion Colloids have been shown to improve CI significantly, and no differences were found between two groups with respect to 28-day mortality, MAP, HR.