人血白蛋白对腹部外科手术患者预后影响的系统评价

The effect of human serum albumin on prognosis of patients with abdominal surgical operation: a systematic review

目的系统评价人血白蛋白（human serum albumin，HSA）对腹部外科手术患者预后的影响。方法检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国知网、维普数据库和万方数据库，检索文献时间截至2014年9月。利用纳入和排除标准对检索到的文献进行筛选，对纳入文献进行质量评价。采用Stata12．0软件进行分析。结果共检索到文献764篇，筛选后纳人18篇随机对照试验，英文和中文各9篇，共1002例患者。Meta分析结果显示，试验组与对照组死亡率（RR=1．42，95％CI：0．72～2．79，P=0．310），总的并发症发生率（RR=1．51，95％CI：1．00～2．30，P=0．051），差异均无统计学意义。感染发生率（RR：1．29，95％“：0．78—2．11）、肺水肿发生率（RR=0．97，95％CI：0．29～3．19）、吻合口开裂发生率（RR=1．14，95％CI：0．66～1．99）、心功能不全发生率（RR=0．63，95％凹：0．17～2．33）、肾功能不全发生率（RR：0．52，95％CI：0．14—1．87），上述数据两组问差异均无统计学意义（均有P〉0．05）。结论现有证据未证明使用HSA与人工胶体液或晶体液对腹部外科手术预后影响有明显差异，对此类患者，不应常规应用HSA。

Objective To systematically evaluate the effect of human serum albumin （HSA） on prognosis of pa- tients with abdominal surgical operation. Methods Database searches, including Cochrane Library, PubMed, Embase, CBM, CNKI, VIP and Wan fang Database, were performed published before September 2014. The quality of retrieved lit- eratures was evaluated based on the inclusion criterion. The Stata 12. 0 software was used for meta-analysis. Results There were 764 retrieved literatures, 18 of them were included on randomized controlled trials in the final analysis, 9 in English and 9 in Chinese, respectively, covering 1 002 patients. Meta-analysis suggested that both the mortality （RR = 1.42, 95% CI： 0. 72-2.79, P =0. 310） and the total complication rate （RR = 1.51, 95% CI： 1.00-2. 30, P =0. 051 ） were not significantly different between the two groups. No statistically significant difference was seen among infection rate （ RR = 1.29, 95% CI： 0. 78-2. 11 ）, pulmonary edema rate （ RR = 0. 97,95% CI： 0. 29-3.19 ） , anastomotic dehiscence rate （RR = 1.14, 95% CI：0. 66-1.99） , heart failure rate （RR =0. 63,95% CI：0. 17-2.33） , and renal dysfunction rate （RR =0. 52, 95% CI：0. 14-1.87）, （all P 〉 0. 05 ）. Conclusions No obvious differences exist in the impacts of using the human serum albumin and artificial colloid or crystalloid solution on prognosis of patients with abdominal surgical opera- tion. HSA should not be routinely applied in these patients.