静态肝素法预冲在血液灌流联合血液透析中的效果的Meta分析

Meta-Analysis of the Role of Static Heparin Priming in Hemoperfusion Combined With Hemodialysis

目的系统评价静态肝素法预冲在血液灌流联合血液透析治疗患者中的有效性、安全性以及成本效益。方法通过计算机检索Sinomed、CNKI、WanFang Data、PubMed、EMbase、The Cochrane Library、ClinicalTrails.gov等数据库建库至2022年11月18日的文献,搜集静态肝素法预冲灌流器与常规预冲法在尿毒症患者血液灌流联合血液透析治疗中的随机对照试验(randomized controlled trial,RCT)。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Review Manager 5.4软件和R meta package 4.1版本进行Meta分析。结果最终纳入17个RCT。Meta分析结果显示与常规预冲法相比,静态肝素法预冲灌流器可降低灌流器凝血发生率(RR=0.32,95%CI:0.14~0.72,Z=2.75,P=0.006);静态肝素法预冲灌流器患者凝血功能未出现明显变化(Z=1.08,P=0.28);静态肝素法预冲灌流器肝素用量(MD=-74.12,95%CI:-84.79~-64.35,Z=13.62,P<0.00001)及生理盐水用量(MD=-797.1,95%CI:-1051.73~-542.49,Z=6.14,P<0.00001)较少,成本效益较好。结论Meta分析显示,静态肝素法预冲灌流器行血液灌流联合血液透析治疗相较于常规预冲法在维持性血液透析患者人群中具有更好的有效性、安全性以及更优的成本效益。受纳入研究数量和质量的限制,上述结论尚需要更多高质量研究予以进一步验证。

Objective To systematically evaluate the efficacy,safety and cost-effectiveness of static heparin priming in patients undergoing hemoperfusion combined with hemodialysis.Methods A computerized search was conducted on various databases including Sinomed,CNKI,WanFang Data,PubMed,EMbase,The Cochrane Library,ClinicalTrails.gov from the inception of the database until November 18,2022,and the randomized controlled trial(RCT)of static heparin prming perfusion cartridge and conventional priming perfusion method in hemoperfusion combined with hemodialysis for uremic patients were collected.After two researchers independently screened the literature,extracted the data and evaluated the bias risk included in the study.Meta-analysis was performed using Review Manager 5.4 and R meta package 4.1 software.Results A total of 17 RCT were finally included.Meta-analysis showed that compared with conventional priming perfusion method,the static heparin priming perfusion cartridge could reduce the coagulation rate(RR=0.32,95%CI:0.14-0.72,Z=2.75,P=0.006),and and the coagulation function of patients with static heparin priming perfusion cartridge did not change significantly(Z=1.08,P=0.28).Static heparin priming perfusion cartridge had less heparin dosage(MD=-74.12,95%CI:-84.79 to-64.35,Z=13.62,P<0.00001)and normal saline dosage(MD=-797.1,95%CI:-1051.73 to-542.49,Z=6.14,P<0.00001),and it had better cost-effectiveness.Conclusion Currently,Meta-analysis shows that static heparin priming perfusion cartridge for hemoperfusion combined with hemodialysis is more effective,safe and cost-effective than conventional priming perfusion method in maintenance hemodialysis patients.Due to the limitation of the quantity and quality of the included studies,the above conclusion needs to be further verified by more high-quality studies.