人工合成血浆扩容剂与白蛋白治疗肝硬化伴大量腹水者疗效的meta分析

A meta analysis of the efficacy of synthetic plasma expander and albumin in the treatment of cirrhosis with massive ascites

目的评估人工血浆扩容剂与白蛋白治疗肝硬化合并大量腹水的疗效。方法在中国知网、万方、维普、PubMed、Embase、Cochrane library数据库,检索人工血浆扩容剂与白蛋白治疗肝硬化合并大量腹水者的随机对照试验相关文献,通过制定纳入与排除标准对文献进行筛选,采用RevMan5.3软件进行数据分析,计算相对危险度(RR)和95%可信区间(95%CI),同时进行I 2检验评价meta分析结果的异质性。结果共纳入6篇文献,结果显示人工血浆扩容剂组肝性脑病发生率、病死率、消化道出血发生率、因腹水再入院率均高于白蛋白组,但差异均无统计学意义(P>0.05);且使用人工血浆扩容剂无明显不良反应。结论大量腹水的肝硬化患者在穿刺放液后静脉输注白蛋白安全性更高,但在白蛋白资源紧缺时仍可选用人工血浆扩容剂来作为代替品。

Objective To evaluate the efficacy of synthetic plasma expander and albumin in the treatment of cirrhosis combined with massive ascites.Methods Database including CNKI,WanFang,VIP,PubMed,Embase,Cochrane library were searched to collect randomized controlled trails that related to synthetic plasma expander and human albumin in the treatment of cirrhosis patients with massive ascites.Accroding to the excluding and including criterias,adopting RevMan5.3 software for data analysis,the relative risk(RR)and 95%confidence interval(95%CI)were calculated,and the heterogeneity of meta analysis results was evaluated by I 2 test.Results A total of 6 articles were included.The results showed that the incidence of hepatic encephalopathy,mortality,incidence of gastrointestinal bleeding,and readmission rate due to ascites in the synthetic plasma expander group were higher than those in the albumin group,but the differences were not statistically significant(P>0.05).Conclusion The safety of intravenous albumin infusion is higher in patients with cirrhosis with massive ascites after paracentesis,but when the human albumin resources are in shortage,the synthetic plasma expander can be used as substitudes.