无肝素抗凝与低分子肝素抗凝对有出血倾向的危重患者连续性血液净化影响的Meta分析

Meta analysis of the effect of continuous blood purification by no heparin and low molecular weight heparin anticoagulation for critically ill patients with bleeding tendency

目的系统评价无肝素抗凝与低分子肝素抗凝用于有出血倾向的危重患者连续性血液净化抗凝治疗的安全性和有效性。方法计算机检索PubMed、MEDLINE、RNAO、OVID、Web of Knowledge、Nursing Consult、EMbase、中国生物医学文献数据库、万方数据库和中国学术期刊全文数据库中关于无肝素抗凝与低分子肝素抗凝用于有出血倾向的危重患者连续性血液净化抗凝治疗效果的随机对照试验(RCT)和半随机对照试验(q-RCT),同时筛检纳入文献的参考文献。由两名研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。结果共纳入7篇文献,Meta分析的结果显示:无肝素抗凝能降低有出血倾向的危重患者出血的发生率。结论无肝素抗凝对于预防有出血倾向的危重患者连续性血液净化抗凝治疗出血并发症的发生具有显著效果。

Objective To systematically evaluate the safety and efficacy of anticoagulation therapy for critically ill patients with bleeding tendency with no-heparin anticoagulation and low molecular weight heparin anticoagulation for the continuous blood purification. Method The Pub Med, MEDLINE, RNAO, OVID, Web of Knowledge, Nursing Consult, EMbase, CBM disc, Wanfang Data and CNKI was searched to collect randomized controlled trials （RCTs） and quasi-randomized controlled trials （q-RCTs） which studied the effects of anticoagulation therapy for critically ill patients with bleeding tendency with no-heparin anticoagulation and low molecular weight heparin anticoagulation for the continuous blood purification. The quality of RCTs and q-RCT were critically appraised, and data were extracted by 2 reviewers independently. Meta-analyses were conducted for the eligible RCTs. Result 7 RCTs were included. The meta-analysis had showed that no heparin can reduce＇the incidence of bleeding for critically ill patients with bleeding tendency. Conclusion No-heparin anticoagulation was effective to prevent bleeding complications of antico- agulant therapy for critically ill patients with bleeding tendency.