人血白蛋白用于心脏外科术后液体复苏的有效性和安全性Meta分析

Efficacy and safety of human albumin for volume resuscitation after cardiac surgery:a Meta-analysis

目的系统评价人血白蛋白(human albumin,HA)用于心脏外科术后液体复苏的有效性和安全性。方法计算机检索PubMed、Embase、Cochrance Library、维普(VIP)、中国知网(CNKI)和万方数据库(Wanfang data),收集HA用于心脏外科术后液体复苏的随机对照试验(randomized controlled trial,RCT),检索时限均为从建库至2019年10月31日,同时手工检索纳入文献的参考文献。由2名研究者独立筛选文献、提取资料,并评价文献质量,采用RevMan 5.3软件进行Meta分析。结果共纳入5个RCT,113例患者。Meta分析结果显示,白蛋白组血流动力学相关指标包括心率(MD=-2.28,95%CI:-6.69~2.13,P=0.31),平均动脉压(MD=0.82,95%CI:-2.22~3.86,P=0.60),中心静脉压(MD=0.05,95%CI:-1.10~1.20,P=0.93),肺毛细血管楔压(MD=0.06,95%CI:-0.74~0.86,P=0.88),心脏指数(MD=0.20,95%CI:-0.07~0.47,P=0.15)与对照组比较差异均无统计学意义;术后出血量方面,白蛋白组的血红蛋白浓度(MD=-4.52,95%CI:-7.36^-1.67,P=0.002)低于对照组,差异有统计学意义。结论当前证据表明,术后应用白蛋白扩容对患者血流动力学的改善并无更好的效果,对于术后出血量的减少方面劣于其他扩容液体,上述结论不支持心脏外科手术患者常规应用白蛋白扩容。

Objective To systematically review the efficacy and safety of human albumin(HA)for volume resuscitation after cardiac surgery. Methods We searched databases including PubMed,Embase,Cochrance Library,VIP,CNKI and Wanfang data to collect randomized controlled trials(RCTs)about human albumin for volume resuscitation after cardiac surgery from inception to October 2019. The references of these RCTs were also searched. Two reviewers independently screened literatures,extracted data and assessed quality of included studies. Then Meta-analysis was performed using RevMan 5.3 software.Results A total of 5 RCTs involving 113 patients were included. The results of Meta-analysis indicated that:there were no significant differences in hemodynamic indexes including heart rate(MD =-2.28,95%CI:-6.69 ~ 2.13,P = 0.31),mean arterial pressure(MD = 0.82,95%CI:-2.22 ~ 3.86,P = 0.60),central venous pressure(MD = 0.05,95%CI:-1.10 ~ 1.20,P =0.93),pulmonary capillary wedge pressure(MD =0.06,95%CI:-0.74 ~ 0.86,P = 0.88),cardiac index(MD = 0.20,95%CI:-0.07 ~ 0.47,P = 0.15).In aspect of postoperative bleeding,haemoglobin(MD =-4.52,95%CI:-7.36 ^-1.67,P =0.002)in the albumin group were lower than those in the control group. Conclusion The current evidence shows that the application of albumin after the operation has no better effect on the improvement of hemodynamics,and the reduction of postoperative blood loss is inferior to that of other expanding fluids. The above conclusions do not support the routine use of human albumin in cardiac surgery patients.