影响脓毒症相关性脑病发生的危险因素的Meta分析

摘要

目的 通过Meta分析方法在较大样本量的前提下,进一步认识重症监护病房中脓毒症患者并发脓毒症相关性脑病(SAE)的危险因素.方法 制定原始文献的纳入标准、排除标准及检索策略,检索PubMed、SCI、EMBASE、Springer、中国期刊全文数据库、万方数据库及维普中文科技期刊数据库等,获得研究脓毒症相关性脑病发生及预后的危险因素的相关文献.文献中脓毒症患者的诊断均符合“2001年危重病医学会/欧洲危重病医学会/美国胸科医师协会/美国胸科学会/外科感染学会关于全身性感染定义国际会议”所制定的脓毒症诊断标准.排除合并高热、低血压、肝肾功能衰竭、高钠血症、低血糖、颅内器质性病变、重度营养缺乏、脑出血、使用镇静药物等能影响中枢神经系统(CNS)症状判断的患者,将最终入选的患者根据有无CNS功能障碍分为两组,SAE组和无脑病组(NE).对文献进行异质性检验,采用RevMan 5.1软件对满足纳入标准的有关脓毒症相关性脑病发生的危险因素的病例对照文献进行Meta分析.结果 共纳入7个病例对照,Meta分析4个主要结局的结果显示:SAE组与NE组比较急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分、丙氨酸氨基转移酶(ALT)水平、天冬氨酸氨基转移酶(AST)水平、pH值的差异均有统计学意义[WMD(95％CI)分别为4.88 (4.64,5.13)、9.43(36.37,42.49)、73.62(71.12,76.13)、-0.04(-0.06,-0.02)].结论 现有研究显示,APACHEⅡ评分、ALT、AST、pH值对SAE的诊断和预警具有重要意义,但鉴于纳入研究较少,样本量小,且质量不高,尚需开展和设计大样本病例对照研究做进一步验证.%Objective To learn the factors of septic associated encephalopathy(SAE)in ICU based on Meta analysis of large samples.Methods The inclusion criteria and exclusion criteria of original literature and retrieval strategy were made strictly.The literatures about studying the incidence and prognostic risk factors about sepsis encephalopathy from the PubMed,SCI,EMBASE,Springer,Weipu and Wanfang database were searched.Diagnosis of patients with sepsis in the literature are in accord with the definition of systemic infection about "society of critical care medicine in 2001/critical care medicine association in Europe/The American College Chest Physicians/American Thoracic Society/Surgical Infection Society about sepsis diagnostic standards in International Conference".The patients with high fever,hypotension,renal failure,hypernatremia,hypoglycemia,intracranial lesions,severe malnutrition,cerebral hemorrhage,and the patients who use of sedative drugs were excluded.Patients were divided into two groups according to whether CNS dysfunction was present,namely the septic associated encephalopathy group(SAE)and no encephalopathy group (NE).Taking into account the possibilities of heterogeneity of the studies,a statistical test for heterogeneity was performed.The Meta analysis was applied with RevMan 5.1 software to analysis the case-control studies of the factors of septic associated encephalopathy.Results A total 7 case-control studies were discovered.Four main final results were showed:the differences of APACHE Ⅱ,ALT level,AST level,pH had statistical significance between SE group and NE group.[WMD(95％CI)were 4.88(4.64,5.13),9.43(36.37,42.49),73.62(71.12,76.13),-0.04(-0.06,-0.02)].Conclusion The exist researches show that the score of APACHE Ⅱ,ALT,AST,pH value have diagnostic and early warning significance in SE.But in view of the fact that the study is less,the sample size is small,and the quality is not high,so it still need to develop and design large sample case control studies for further verification.