限制性液体复苏对骨盆型严重创伤病人凝血功能影响的Meta分析

Effect of limited fluid resuscitation on coagulation function in patients with severe pelvic trauma:a Meta-analysis

目的:系统评价限制性液体复苏对骨盆型严重创伤病人复苏后凝血功能改善及降低病死率的影响。方法:检索the Cochrane Library、EMbase、PubMed、中国知网、万方等数据库中研究对象为骨盆型严重创伤病人,研究指标包含明确的复苏后凝血功能指标和病死率的随机对照试验或类实验研究。应用RevMan 5.4.1软件进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型进行数据合并,计算合并效应量及其95%置信区间(CI),采用绘制漏斗图法评估发表偏倚。结果:最终纳入11篇文献,涉及821例病人。Meta分析结果显示,与常规液体复苏相比较,采用限制性液体复苏治疗可以增加复苏后骨盆型严重创伤病人的血小板计数[MD=32.09,95%CI(29.39,34.79),P<0.00001]和纤维蛋白原含量[MD=1.42,95%CI(1.14,1.70),P<0.00001],降低血浆凝血酶原时间[MD=-5.90,95%CI(-7.10,-4.71),P<0.00001]和活化部分凝血活酶时间[MD=-8.07,95%CI(-11.84,-4.29),P<0.0001],降低病死率[RR=0.24,95%CI(0.15,0.37),P<0.00001]。结论:现有证据表明,限制性液体复苏方案能改善骨盆型严重创伤病人液体复苏后的凝血功能,降低病死率。推荐应用限制性液体复苏对骨盆型严重创伤病人实施早期复苏,遵循个体化原则,结合病人病情,权衡利弊,降低并发症的发生,保障病人安全。

Objective:To systematically evaluate the effect of limited fluid resuscitation on the improvement of coagulation function and reduction of mortality in patients with severe pelvic trauma after resuscitation.Methods:Randomized controlled trials or quasi-trials were retrieved from the Cochrane Library,EMbase,PubMed,CNKI,WanFang Database and other databases.The subjects were patients with severe pelvic trauma,and the study indexes included clear post-resuscitation coagulation function indexes and mortality.RevMan 5.4.1 software was used for Meta-analysis.Based on the heterogeneity test results,either the fixed-effect model or the random-effect model was selected for data merge,the merge effect and its 95% confidence interval(CI)were calculated,and the funnel plot method was used to assess publication bias.Results:A total of 11 articles were included,with a total of 821 patients.Meta-analysis results showed that compared with conventional fluid resuscitation,limited fluid resuscitation could increase the platelet count of patients with severe pelvic trauma after resuscitation[MD=32.09,95%CI(29.39,34.79),P<0.00001],and fibrinogen content[MD=1.42,95%CI(1.14,1.70),P<0.00001],reduce prothrombin time[MD=-5.90,95%CI(-7.10,-4.71),P<0.00001];activated partial thromboplastin time[MD=-8.07,95%CI(-11.84,-4.29),P<0.0001],and the mortality rate[RR=0.24,95%CI(0.15,0.37),P<0.00001].Conclusions:Existing evidences show that limited fluid resuscitation can improve the coagulation function of patients with severe pelvic trauma after fluid resuscitation and reduce the fatality rate.It is recommended to use limited liquid resuscitation to implement early resuscitation for patients with severe pelvic trauma,follow the principle of individualization,combine the patient′s condition,weigh the pros and cons,reduce the occurrence of complications,and ensure patient safety.