高渗溶液不能降低创伤失血性休克的病死率:系统评价研究

摘要

目的 系统地评价高渗盐溶液(hypertonic saline)复苏治疗对创伤性休克(traumaticshock,TS)患者临床预后的影响.方法 检索2002年1月至2012年8月中英文7个生物医学数据库,建立随机对照试验(RCT)纳入排除标准进行鉴定.采用Cochrane评价员手册5.0.1及改良Jadad质量评分进行质量评定.用RevMan5.1软件进行Meta分析.结果 检索到的221篇相关文献中,共5个随机对照研究符合全部纳入标准.Meta分析主要发现了早期复苏使用高渗溶液不能降低患者早期(入院后48 h内)病死率(RR=1.04,P=0.74)和远期(伤后7d至3个月)病死率(RR=0.97,P=072);亦不能减少首日输液量和红细胞悬液输注量(P=0.38),不能降低院内感染事件(RR=1.04,P=0.70)、住ICU时间(P=0.20)和总住院时间.结论 高渗溶液复苏与常规复苏措施相比,不能改善创伤失血性休克患者的病死率以及院内感染率,其对治疗首日输液总量和输血量无显著影响,且不能减少住院总时间和住ICU时间.需要更多大样本且方法学质量高的随机对照试验对高渗液体是否可改变创伤失血性休克患者住院时间及住院费用等进行研究.%Objective To evaluate systematically whether administration of hypertonic saline transfusion affects clinical outcomes with compared to standard fluid in the early stage of resuscitation for traumatic shock patients.Methods Seven English and Chinese routine biology and medicine databases were searched for randomized controlled trials (RCTs) published from January 2002 to August 2012,and established inclusion and exclusion criteria to evaluate these RCTs.The 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 After evaluated 211 related literatures,five RCTs met all the inclusion criteria and were enrolled for meta-analysis.The meta-a nalysis demonstrated that early hypertonic transfusion did not decrease short-term (first 48 hours after admission) mortality (RR =1.04,P =0.74); nor did it decrease later-term (7day to 3month after injury) mortality (RR =0.97,P =0.72).It also did not decrease the total volume of fluid and blood transfusion required during the first day (P =0.38).Similarly,it did not affect the incidents of infections (RR =1.04,P =0.70),the length of stay in ICU (P =0.2) and total length of stay in the hospital.Conclusions Compared to standard fluid,there was no advantage on mortality and hospital infection by using hypertonic supplement transfusion in the early stage of resuscitation for traumatic shock patients.Hypertonic transfusion did not have any significant effect on the volume of total fluid and blood transfusion required the first day,and no trend of reduction for the length of ICU and hospital stay.Further well-designed randomized controlled trials are needed to demonstrate the cost effectiveness of hypertonic transfusion to traumatic shock patients while in ICU.