急诊腹膜透析在终末期肾脏病患者中应用的Meta分析

Emergency peritoneal dialysis in patients with end-stage renal disease:a Meta-analysis

目的对急诊腹膜透析与常规腹膜透析安全性及患者预后进行Meta分析。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库及维普数据库中从建库至2020年1月关于急诊腹膜透析(腹膜透析管置入<14 d)与常规腹膜透析(腹膜透析管置入≥14 d)的研究,由2名研究者独立筛选文献和提取资料,并进行文献质量评价。采用RevMan 5.3软件对纳入的文献进行Meta分析。结果本研究共纳入8篇文献,涉及1446例患者,Meta分析显示:与常规腹膜透析相比,急诊腹膜透析患者在患者病死率[RR=1.48;95%CI(0.71~3.08);Z=1.04,P=0.30]、技术生存率[RR=0.98;95%CI(0.92~1.04);Z=0.59,P=0.55]、感染性并发症[RR=1.07;95%CI(0.83~1.37);Z=0.50,P=0.62]和机械性并发症[RR=1.49;95%CI(0.90~2.45);Z=1.56,P=0.12]发生率中显示两组差异均无统计学意义。进一步通过机械性并发症亚组分析发现,急诊腹膜透析与更高的渗漏率相关[RR=3.73;95%CI(1.79~7.77);Z=3.52,P=0.0004]。结论急诊腹膜透析与常规腹膜透析患者在病死率、技术生存率、感染性并发症发生率方面差异无统计学意义,但急诊腹膜透析可能会增加渗漏发生风险。

Objective To explore the safety and patient outcomes of emergency peritoneal dialysis(PD)among individuals with end-stage kidney disease compared to those with conventional peritoneal dialysis by meta-analysis.Methods The databases of PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,WanFang and VIP were searched by computer up until January 2020.Cohort studies were examined for comparing the safety and patient outcomes of emergency PD(<14 days post-catheterization)to those with conventional PD(≥14 days post-catheterization),two researchers independently screened the literature,extracted data and evaluated literature quality.The enrolled studies were conducted for Meta-analysis with RevMan5.3 software.Results Eight studies involving 1,446 patients were identified.Compared with conventional PD,mortality rate[RR=1.48;95%CI(0.71-3.08);Z=1.04,P=0.30],technical survival rate[RR=0.98;95%CI(0.92-1.04);Z=0.59,P=0.55],infectious complications[RR=1.07;95%CI(0.83-1.37);Z=0.50,P=0.62]and mechanical complications[RR=1.49;95%CI(0.90-2.45);Z=1.56,P=0.12]of emergency PD showed no statistical difference.The subgroup analysis of mechanical complications revealed that emergency PD was associated with a higher leakage rate[RR=3.73;95%CI(1.79-7.77);Z=3.52,P=0.0004].Conclusion No significant inter-group difference exists in mortality,technical survival rate or incidence of infectious complications.However,emergency PD may elevate the risk of leakage.