常规治疗联合连续性静脉—静脉血液滤过治疗急性呼吸窘迫综合征的Meta分析

Effectiveness of conventional treatment combined with continuous veno-venous hemofiltrationon treatment of acute respiratory distress syndrome: a Meta-analysis

目的系统评价常规治疗联合连续性静脉—静脉血液滤过(CVVH)治疗急性呼吸窘迫综合征(ARDS)的疗效。方法计算机检索Pub Med、The Cochrane Library、EMbase、中国知网数据库、中国生物医学文献数据库、中文科技期刊数据库(维普)及万方数据库,全面收集常规治疗联合CVVH和常规治疗ARDS的随机对照试验。检索时限均从建库至2014年11月2日。由2位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量,采用Rev Man5.2软件进行Meta分析。结果纳入7个随机对照试验和3个半随机对照试验,620例患者。Meta分析结果显示,常规治疗联合CVVH组与常规治疗组比较,能降低病死率[OR=0.27,95%CI(0.17,0.43),P<0.000 01],提高24 h氧合指数[MD=49.59,95%CI(24.36,74.81),P<0.000 1]和72 h氧合指数[MD=64.66,95%CI(25.27,104.04),P<0.001]),缩短机械通气时间[MD=-3.43,95%CI(-4.23,-2.64),P<0.000 01],减少呼吸机相关性肺炎发生率[OR=0.21,95%CI(0.10,0.42),P<0.000 01],缩短住重症监护病房时间[MD=-1.16,95%CI(-1.65,-0.67),P<0.000 01],差异均有统计学意义。结论与常规治疗相比,常规治疗联合CVVH能降低ARDS患者病死率,提高氧合指数,缩短机械通气时间,减少呼吸机相关性肺炎,缩短住重症监护病房时间。但该结论的临床应用可行性仍需进一步证明。

Objective To systematically review the effectiveness of conventional treatment combined with continuous veno-venous hemofiltration（CVVH）on the treatment of acute respiratory distress syndrome（AR-DS）. Methods PubMed, The Cochrane Library （Issue 11, 2014）, EMbase, CNKI, CBM, VIP and Wan-Fang Data for the randomized controlled studies （RCTs） related to CVVH combined conventional treatment versus conventional treatment for ARDS were searched. From inception to April 2014 two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then Meta-analysis was performed using RevMan 5.2 software. Results A total of 7 RCTs and 3 q-RCTs involving 620 patients were included. The results of Meta-analysis showed that CVVH combined conventional treatment in decreasing the mortality[OR=0.21, 95%CI （0.17, 0.43）], improving oxygenation （24 h：[MD=49.59, 95%CI （24.36, 74.81）], 72 h：[MD=64.66, 95%CI （25.27, 104.04）] ）, shortening the duration of mechanical ventila-tion [MD =-3.43, 95% CI （-4.23,-2.64）], reducing the incidence of ventilator-associated pneumoniathe （VAP） [MD=0.21, 95%CI （0.10, 0.42）] and curtailing the length of ICU stay [MD=-1.16, 95%CI （-1.65,-0.67）] was better than conventional treatment. Conclusion CVVH combined conventional treatment can de-crease the mortality, improve oxygenation, shorten the duration of mechanical ventilation, decrease the inci-dence of VAP and shorten the length of ICU stay in patients with ARDS. However, the clinical feasibility of the conclusions still needs further proofs.