连续性血液净化治疗严重烧伤脓毒症临床疗效的Meta分析

Systematic review on the clinical effect of continuous blood purification treatment of severe burn sepsis

目的系统评价连续性血液净化技术（CBP）治疗严重烧伤脓毒症的疗效。方法计算机检索中文生物医学文献库（CBM）、维普电子资源、万方电子资源网、中国知网（CNKI）等数据库,纳入以CBP为干预措施治疗严重烧伤脓毒症的临床对照研究。按照Cochrane系统评价方法,初步选择符合研究目的及纳入和排除标准的文献、通过阅读全文进一步筛选和剔除,对最终纳入的文献进行改良的Jadad方法学质量评价后,采用Revman 5.3软件对数据进行Meta分析。结果本文共纳入6项研究,包括274例严重烧伤脓毒症患者,平均年龄在30~45岁之间,烧伤面积〉30%,但研究方法学质量不高。Meta分析结果显示,与常规治疗组比较,CBP组治疗严重烧伤脓毒症可显著降低患者血液中炎性因子指标,分析结果显示：CBP组治疗前后血肌酐下降度大于对照组（P〈0.01）;CBP组治疗前后血尿素氮下降度大于对照组（P〈0.01）;CBP组治疗前后TNF-α下降度大于对照组（P〈0.000 1）,CBP组治疗前后血氧分压上升幅度大于对照组（P〈0.000 01）。结论治疗严重烧伤脓毒症时联合CBP治疗优于常规治疗,能有效降低炎性因子和机体代谢产物,改善组织氧供,减轻对细胞的损伤,对于烧伤脓毒症的治疗具有重要意义。

Objective To evaluate the effect of treatment of continuous blood purification in severe burn sepsis patients.MethodsStudies were identified through the electronic database of WanFang, CNKI, VIP and CBM up to now for clinical control study on treatment of severe burn sepsis with technology of continuous blood purification. After the initial selection meeting the research purposes and the inclusive and exclusive criteria of the literature, the further culling through full text of screening and reading, and the modified Jadad methodological evaluation for eventual inclusion literature, obtained data was analyzed by Revman 5.3 software.Results Six of the studies was concluded, containing 274 severe burn sepsis patients, mean age was 30-45 years old with burn size larger than 30%. Meta-analysis showed that compared with traditional group, the level of inflammatory factors of CBP group could be reduced obviously.ConclusionTreatment combined with CBP is more benefit compared with traditional, it could reduce inflammatory factors and metabolite in blood effectively, and improve the amount of oxygen in tissue, reduce injury to cell. All that means CBP is significantly in burn sepsis treatments.