持续输注呋塞米对急性肾损伤或急性肾损伤风险患者预后的Meta分析

Meta-analysis of Continuous Infusion of Furosemide on the Prognosis of Patients with Acute Renal Injury or Risk of Acute Renal Injury

目的评价持续输注呋塞米对急性肾损伤(AKI)或有AKI风险患者预后的影响。方法检索PubMed、EMBASE、Cochrane Library和Web of Science数据库从建库到2018年7月公开发表的相关随机对照实验,同时检索纳入文献的参考文献及相关系统评价或Meta分析,对纳入文献进行质量评价及资料提取。二分类变量选取相对危险度(RR),连续性变量选取均数差(MD),采用RevMan 5.3软件对数据进行Meta分析。结果纳入20篇随机对照研究共1564例患者。Meta分析结果表明,与对照组相比,连续输注呋塞米组全因病死率(RR=0.84,95%CI:0.64~1.11,P=0.23)、ICU住院时间(MD=0.08,95%CI:0.29~0.45,P=0.67)、AKI发生率(包括恶化及新发)(RR=1.06,95%CI:0.81~1.37,P=0.68)和肾脏替代治疗(RRT)比例(RR=0.83,95%CI:0.45~1.51,P=0.54)差异均无统计学意义。结论持续输注呋塞米不能降低AKI或有AKI风险患者的病死率,对ICU住院时间、AKI发生率、RRT比例和预后方面均无改善作用。

Objective To evaluate the effect of continuous furosemide infusion on the prognosis of patients with acute kidney injury(AKI)or at risk of AKI.Methods The PubMed,EMBASE,the Cochrane Library and Web of Science databases were searched for randomized controlled trials(RCT)from their inception until July 2018.At the same time,the relevant references that were finally included in the literature and the systematic review or Meta-analysis studies related to the study were searched.The quality of the included literature was evaluated and the data was extracted.The relative risk(RR)was selected for the two categorical variables,and the mean difference(MD)was selected for the continuous variables.RevMan 5.3 software was used for Meta-analysis of data.Results A total of 1564 patients from 20 articles were included in the Meta-analysis showing that compared with the control group,there was no statistical difference in all-cause mortality(RR=0.84,95%CI:0.64-1.11,P=0.23),length of ICU stay(MD=0.08,95%CI:0.29-0.45,P=0.67),AKI incidence(including deterioration and new)(RR=1.06,95%CI:0.81-1.37,P=0.68),and renal replacement therapy(RRT)ratio(RR=0.83,95%CI:0.45-1.51,P=0.54)in the continuous furosemide group.Conclusion Continuous infusion of furosemide cannot reduce the mortality of patients with AKI or at risk of AKI,and has no effect on the length of ICU stay,the incidence of AKI,the ratio of RRT,and the prognosis.