损伤控制复苏治疗创伤的系统评价与 Meta 分析

Systematic review and meta-analysis of damage control resuscitation in trauma patients

目的：综合分析损伤控制复苏（damage control resuscitation， DCR）治疗创伤患者的有效性及安全性，为创伤治疗决策提供依据。方法计算机检索PubMed、The Cochrane library、OvidSP、ScienceDirect和ProQuest Health＆Medical Complete 等数据库中收录的有关DCR治疗创伤的相关文献，依据 Cochrane 系统评价手册5．1．0版推荐的质量评价标准对随机对照试验（ randomized controlled trial ， RCT）进行评价，依据Newcastle Ottawa Scale 量表中病例对照研究的质量评价标准对病例对照研究（case control study， CCS）进行评价，使用Review Manager 5．2统计学软件进行数据的分析和综合，并绘制森林图、漏斗图。结果共纳入7篇文献，其中CCS 7篇， RCT 0篇，共7786例患者， DCR组2581例，非损伤控制复苏（ non -damage control resuscitation ， NDCR）5205例。 DCR组与NDCR组相比：总住院时间差异有统计学意义[ MD＝1．76，95％CI （1.25，2．27），P＜0．05]，ICU住院时间差异无统计学意义[MD＝0．90，95％CI （-0．73，2．52）， P＝0．28]，死亡率差异无统计学意义[OR＝0．66，95％CI（0．42，1．03），P＝0．06]，但纳入研究可能存在发表偏倚。结论依据目前的资料，尚不能认为DCR可以降低患者死亡率和缩短ICU住院时间，同时DCR组总住院时间更长。但由于所纳入的研究都是CCS，未纳入RCT，证据等级较低，迫切需要有多中心的RCT以获得更有力的循证医学证据。

Objective In order to provide some evidence for the treatment decisions of trauma , the present study analyzed the efficiency and security of damage control resuscitation （ DCR ） in trauma patients.Methods Literatures about DCR in trauma patients were searched from several databases including PubMed, the Cochrane library, OvidSP, ScienceDirect and ProQuest Health ＆amp; Medical Complete.Randomized controlled trial（RCT） was evaluated by the Cochrane handbook 5.1.0 and the case control study（CCS） was evaluated by the Newcastle Ottawa Scale .The analysis and synthesis of data was conducted by the Review Manager 5.2 statistics software, and drawn the forest graph and the funnel plot .Results Seven articles which included 7 CCSs and 0 RCT were taken in this research which included 7786 patients.There are 2581 patients in DCR and 5205 patients in non -damage control resuscitation （ NDCR） .The results of meta -analysis between DCR and NDCR were as follows：1.The length of hospital stay between the two groups was statistically significant [ MD=1.76,95%CI （1.25, 2.27）,P〈0.01].2.The length of ICU stay was not statistically significant [MD=0.90,95%CI （-0.73, 2.52）, P=0.28].3.The mortality was not statistically significant [OR=0.66,95%CI （0.42,1.03）, P=0.06], meanwhile the included articles have publication bias .Conclusion DCR can not reduce the mortality of trauma patients and the length of ICU stay , in contrast the length of＆amp;nbsp;hospital stay in the DCR group is longer .As the studies included are CCSs which are low level of evidence , it is of urgent need to develop multi -center RCTs to get stronger evidence of evidence -based medicine .