连续性肾脏替代治疗与间歇性血液透析治疗伴急性肾衰竭的多器官功能障碍综合征疗效的Meta分析

Efficacy of continuous renal replacement treatment and intermittent hemodialysis for treatment of multiple organ dysfunction syndrome with acute renal failure: a meta-analysis

目的评价连续性肾脏替代治疗(CRRT)与间歇性血液透析(IHD)治疗伴急性肾衰竭的多器官功能障碍综合征(MODS)的疗效,为指导临床实践提供可靠的循证医学证据。方法计算机检索万方数据库、中国学术期刊网全文数据库(CNKI)和维普数据库、PubMed、the Cochrane Library、MEDLINE从建库至2012年收录的CRRT与IHD治疗MODS的临床对照试验,并对纳入文献采用Rev.Man 5.0进行Meta分析。结果 8篇文献共572例患者纳入研究,其中行CRRT 286例,IHD 286例。Meta分析结果显示:与IHD比较,CRRT治疗后2日和3日血肌酐降低程度更低(MD-280.26,95%CI[-477.39,-83.13],P=0.005;MD-151.89,95%CI[-227.26,-76.53],P<0.0001)且血碳酸氢根浓度增加程度更高(MD 6.85,95%CI[1.56,12.13],P=0.01;MD 4.26,95%CI[2.35,6.17],P<0.0001),治疗后3日的pH值升高更为明显(MD 0.07,95%CI[0.03,0.10],P=0.0005);而在尿素氮、治疗后1日血肌酐和血碳酸氢根、治疗后1日和2日血pH、生存率及死亡率方面,CRRT与IHD两组间差异无统计学意义(P>0.05)。结论连续性肾脏替代治疗可作为传统间歇性血液透析治疗伴急性肾衰竭的多器官功能障碍综合征的一种理想替代方法,尚不能证明其可完全替代间歇性血液透析。

Objective To evaluate the efficacy of continuous renal replacement therapy （CRRT） and intermittent hemodialysis （IHD） in treatment of multiple organ dysfunction syn- drome （MODS） with acute renal failure comprehensively and objectively, provide reliable evi- dence for guiding clinical practice. Methods All clinical controlled trials in the Wanfang Da- tabase, CNKI, VIP Database, PubMed, the Cochrane Library and MEDLINE from those data- bases built to 2012 about CRRT and IHD to treat MODS were searched, and those selected studies were used to make a recta-analysis using Rev. Man 5.0. Results Eight studies inclu-ding a total of 572 cases （ CRRT ： 286 ; IHD ： 286） were included. The results of meta analysis showed that compared with IHD, the degree of serum creatinine reduced more than that treated via CRRT after the second and third day（ MD -280. 26, 95% CI [ -477.39, -83.13 ] , P = 0. 005 ; MD - 151.89, 95% CI [ -227.26, -76. 53 ] , P 〈0. 0001 ） and the degree of blood bicarbonate concentration （ MD 6.85, 95% CI [ 1.56,12. 13] , P = 0. 01 ; MD 4.26, 95% CI [2.35, 6. 17], P〈0.0001） and pH （MD 0.07, 95%CI [0.03, 0. 10], P =0.0005） （at the third day） increased more, while the urea nitrogen, serum creatinine and blood carbonated hydrogen root, blood pH in the first and second day after treatment, survival and mortality had no difference between CRRT and IHD （P 〉 0. 05）. Conclusion At present, CRRT is an ide- al alternative to treat patients with MODS associated with acute renal failure, but there is no a- vailable evidence to indicate that CRRT can completely replace IHD.