液体复苏对感染性休克儿童病死率影响的meta分析

摘要/Abstract

摘要：

　目的　评价不同液体复苏治疗对感染性休克（septic shock）儿童临床预后的影响。方法　检索2003年1月至2013年5月文献，选择患儿年龄1个月~15岁，以接受早期不同液体复苏作为研究组与对照组唯一差别，报告临床结局指标的随机对照研究；按Cochrane评价员手册及改良Jadad质量评分进行评定；RevMan5.0软件进行meta分析。结果　在181篇相关文献中8项符合标准。有关病死率，5项研究比较使用胶体液或晶体液，固定效应模式合并相对风险度（RR）=0.95，95%CI：0.76~1.19（P=0.66）；3项研究比较使用不同胶体液，固定效应模式合并RR=0.47，95%CI：0.14~1.63（P=0.23）；4项研究比较液体复苏或传统复苏，剔除1项研究后，固定效应模式合并RR=1.44，95%CI：1.13~1.83，差异有统计学意义（P=0.003）。有关并发肺水肿，2项研究比较使用胶体液或晶体液，随机效应模式合并RR=1.11，95%CI：0.13~9.71（P=0.93）；4项研究比较液体复苏或传统复苏，随机效应模式合并RR=0.83，95%CI：0.21~3.29（P=0.79）。有关复苏8 h内需抢救者，2项研究比较使用胶体液或晶体液，固定效应模式合并RR=2.43，95%CI：0.71~8.36（P=0.16）；2项研究比较液体复苏或传统复苏，固定效应模式RR=0.43，95%CI：0.19~0.97，差异有统计学意义（P=0.04）。结论　不同的胶体或晶体复苏液体在感染性休克患儿早期救治中的功效无明显差异。

Abstract: 　Objectives　To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with septic shock. Methods Medline, SCI, Embase, Cochrane Library, Google scholar and Chinese Biomedicine Database were searched for randomized controlled trials in children ages one month to 15 years with septic shock published between Jan, 2003 and May, 2013. The form or volume of transfusion with crystalloids or colloids was the only difference between the intervention and control groups. Methodological quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and Jadad’s score scale. RevMan 5.0 statistical software was used for meta-analysis. Results In 181 relative articles, 8 trials met the criteria. On fatality rate, 5 trails compared colloids with crystalloids, and the fixed model was applied RR＝0.95, 95%CI:0.76~1.19 (P=0.66); 3 trails compared different forms of colloids, and the fixed model was applied RR＝0.47, 95%CI :0.14~1.63 (P=0.23); 4 trails compared fluid resuscitation with traditional therapy, after excluded one trail, the fixed model was applied RR＝1.44, 95%CI:1.13~1.83 (P=0.003). On complication of pulmonary edema, 2 trails compared colloids with crystalloids, and the random effect model was applied RR=1.11, 95%CI :0.13～9.71 (P=0.93); 4 trails compared fluid resuscitation with traditional therapy, and the random effect model was applied RR=0.83, 95%CI:0.21～3.29 (P=0.79). On 8-hour emergency rescue, 2 trails compared colloids with crystalloids, and the fixed model was applied RR＝2.43, 95%CI:0.71~8.36 (P=0.16); 2 trails compared fluid resuscitation with traditional therapy, and the fixed model was applied RR=0.43, 95%CI:0.19~0.97 (P=0.04). Conclusions There is no significant difference between colloids and crystalloids in the effect of fluid resuscitation for children with septic shock.

刘婕陶晔璇蔡威. 液体复苏对感染性休克儿童病死率影响的meta分析[J]. 临床儿科杂志, 2014, 32(1): 70-75.

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