限制性液体管理对急性肺损伤患者预后影响的荟萃分析

Effect of conservative fluid management strategy on the outcomes in patients with acute lung injury：a Meta-analysis

目的评价限制性液体管理对急性肺损伤患者预后的影响。方法采用Cochrane系统评价的方法，通过计算机和手工检索收集国内外1990年1月113至2010年5月20日关于限制性液体管理对急性肺损伤患者预后的随机对照研究（RCT）、病例对照研究。结果共纳入4项RCT和3项回顾性对照研究。4项RCT研究共1178例患者，包括限制性液体管理组594例，对照组584例，与对照组相比，限制性液体管理不能显著降低急性肺损伤患者的病死率（P=0．16）。3项回顾性对照研究共1046例患者，包括实现限制性液体管理296例，对照组750例，统计显示实现限制性液体管理者病死率明显低（P〈0．001）。对4项RCT研究进一步分析显示，限制性液体管理可缩短机械通气时间，不会显著增加肾功能损害。结论限制性液体管理不能明显降低急性肺损伤患者的病死率，但可以缩短机械通气时间，仍有必要进行更多大样本、高质量的RCT研究。

Objective To evaluate the effect of conservative fluid management on the outcomes in patients with acute lung injury （ALI）. Methods Randomized controlled trials （RCTs） and cohort trials on conservative fluid management from January 1, 1990 to May 20, 2010 were retrieved by electronic and manual searching. A meta-analysis of effect of conservative fluid management on the outcomes in ALI patients was conducted by the methods as recommended by the Cochrane Collaboration. Results Four RCTs involving 594 cases in conservative fluid management group and 584 in conventional fluid management group were included into the Meta-analysis. Compared with the conventional fluid management group, there was no beneficial effect of conservative fluid management strategy on mortality in ALl patients （P = 0. 16）. However, the duration of mechanical ventilation was shortened while the incidence of renal failure remained unchanged. Three retrospective cohort trials involving 296 cases in conservative fluid management group and 750 in conventional fluid management group were included into the recta-analysis. As compared with the conventional fluid management strategy, conservative fluid management strategy had improved the patient outcomes （P 〈 0. 001 ）. Conclusion No beneficial effect of conservative fluid management strategy on the mortality is observed in the ALI patients. And the ventilator-free durations become elongated. However, further trials of a larger sample size and a higher quality are warranted.