高渗盐溶液对失代偿心力衰竭患者疗效的Meta分析

Meta-analysis of the effect of hypertonic saline solution on patients with decompensated heart failure

目的系统评价高渗盐溶液(HSS)在慢性失代偿性心衰患者治疗中的疗效。方法计算机检索Pub Med、Cochrane图书馆、Embase、CNKI、CBM、VIP及万方等数据库,全面收集公开发表的内容关于高渗盐加利尿剂或者单用利尿剂治疗心衰的随机对照试验。检索时间限定为从建库至2016年12月,并追溯相关参考文献。由两名研究者严格遵从纳入与排除标准筛选文献、提取数据资料、评价研究质量,用Revman5.35软件进行Meta分析。结果初步检索出110篇文献,最终共5篇RCT符合纳入标准,共2064例患者。Meta分析结果显示:高渗盐联合利尿剂治疗后,在全因死亡方面明显优于单用利尿剂组,差异有统计学意义(RR=1.81,95%CI:1.53~2.15,P=0.23);再入院风险偏低(RR=1.99,95%CI:1.32~3.00,P=0.05)。结论联合使用高渗盐溶液能够改善失代偿性心衰患者的死亡率。对此结论的解释应保持谨慎,尚需更多设计严格、随访时间足够长以及高质量的大样本随机对照试验来验证。

Objective To explore the effect of small volume hypertonic saline solution(HSS)on patients withdecompensated chronic heart failure(CHF).Methods We electronically searched the following databases includingPubmed,Cochrane,Medline,EMbase,CBM,CNKI,VIP and WanFang Database to collect randomized controlledtrials(RCTs)from inception to December,2016.Two reviewers independently screened literature according tothe inclusion and exclusion criteria,extracted data and assessed the quality of the included studies.Then,metaanalysiswas Performed using RevMan5.3software.Results A total of5RCTs involving2064patients wereincluded.Compared to HSS combined with diuretic,using diuretic alone had significantly higher mortality(RR=1.81,95%CI:1.53~2.15,P=0.23),and higher risk of re-admission(RR=1.99,95%CI:1.2~3.00,P=0.05).ConclusionCombined use of hypertonic saline solution can improve the mortality of CHF patients.The interpretation of thisconclusion should be kept cautious.High quality studies with large sample size,rigorous design and long follow-uptime are needed.