限制性液体复苏对脓毒症休克患者疗效的meta分析

Efficacy of restricted fluid resuscitation in patients with septic shock:a meta analysis

目的探究限制性液体复苏对脓毒症休克患者的治疗效果。方法计算检索Pubmed、Cochrane Library、Embase、Web of science、中国知网及维普和万方的数据库,搜集有关限制性液体复苏对脓毒症休克患者治疗效果和预后的影响的随机对照试验(RCT),检索时限均为建库至2020年9月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果本文共纳入7个RCT,614例患者。Meta分析结果显示,限制液体复苏组和常规足量液体复苏组相比病死率降低,(OR=0.65,95%CI=0.43~0.98,P<0.05),重症监护病房(ICU)住院时间(LoS)同样降低,差异有统计学意义[平均差异(MD)=-3.28,95%CI=-4.08~2.49,P<0.05],但急性肾损伤发生率差异无明显统计学意义(OR=0.69,95%CI=0.53~2.26,P>0.05)。结论对于脓毒症休克患者与常规足量液体复苏相比,限制性液体复苏的病死率和ICU住院时间都降低,但是虽然液体输入总量减少,急性肾损伤的副作用不良反应却没有改善。总体而言限制性液体复苏,在治疗效果和经济角度都优于常规足量液体复苏,可以根据病情适当选用。

Objective To investigate the curative effect of restrictive fluid resuscitation therapy in septic shock patients.Methods We searched the PubMed,Cochrane Library,Embase,Web of Science,CNKI,VIP and WanFang databases to collect randomized controlled trials(RCT)on the effects of restrictive fluid resuscitation on the treatment and prognosis of patients with septic shock.The search time limit was from the establishment of the database to September 30,2020.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies.RevMan 5.3 software was used for meta-analysis.Results Seven studies containing 614 patients with septic shock were analyzed in the meta-analysis.The results showed that the mortality of the group with restricted fluid resuscitation was lower than that of the group with conventional adequate fluid resuscitation(OR=0.65,95%CI=0.43~0.98,P<0.05),and the length of stay in the ICU LoS was also lower[mean difference(MD)=-3.28,95%CI=-4.08~-2.49,P<0.05)].But there was no statistically difference in the incidence of acute kidney injury(OR=0.69,95%CI=0.53~2.26;P>0.05).Conclusion Compared with conventional adequate fluid resuscitation,restrictive fluid resuscitation in patients with septic shock has reduced mortality and ICU LoS.However,although the total fluid input is decreased,the side effects of acute kidney injury have not ameliorated.In general,it is superior to conventional fluid resuscitation in terms of therapeutic effect and economics,and can be used as clinically needed.