不同剂量CVVH治疗脓毒症患者预后的meta分析

发布时间：2017-12-28 18:13

本文关键词：不同剂量CVVH治疗脓毒症患者预后的meta分析　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

更多相关文章： CVVH 血液净化 脓毒症 剂量 meta分析

【摘要】：目的：系统评价不同剂量CVVH治疗脓毒症患者的预后,为临床确定脓毒症的CRRT治疗剂量提供参考。方法：电子检索Pubmed、Embase、Cochrane Library、中国知网、万方和维普中文科技期刊6个文献数据库,搜索范围是从建库至2015年4月的所有文献,纳入涉及不同剂量CVVH治疗脓毒症的随机对照研究,根据纳入标准和排除标准筛选文献,经质量评价及提取数据后,使用Review Manager 5.2软件对接受不同剂量CVVH治疗的脓毒症患者的病死率、肾功能恢复时间、ICU停留时间等预后指标进行数据统计分析,病死率采用相对危险度(RR)为效应量,肾功能恢复时间及ICU停留时间采用加权均数差(WMD)为效应量。结果：纳入随机对照研究(RCT)文献12篇,共有2343位患者。Meta分析结果显示当将低剂量组和高剂量组分别设定为35 ml/(kg·h)、≥ 35 ml/(kg·h)时,低剂量组病死率[RR=1.07,95%CI= 0.91 1.27),P=0.40],14-15天病死率[RR=1.41,95%CI=(0.80,2.52), P=0.24],14-30天病死率[RR=1.27,95%CI=(0.99,1.64), P=0.06],30-60天病死率[RR=1.13,95%CI=(0.71,1.79),P=0.60],60-90天病死率[RR=1.00,95%CI=(0.85,1.19),P=0.98]。当将低剂量组和高剂量组分别设定为45 ml/(kg·h)、≥45 ml/(kg·h)时,低剂量组病死率[RR=1.24,95%CI=(1.01,1.52),P=0.04],28天病死率[RR=1.74,95% CI=(1.01,2.99), P=0.04],60天病死率[RR=1.08,95% CI=(0.85,1.36),P=0.53],28-60天病死率[RR=1.18,95%CI=(0.95,1.46),P=0.13],60-90天病死率[RR=1.25,95% CI=(0.80, 1.97),P=0.32],肾功能恢复时间[WMD=3.89,95% CI=(2.68,5.09),P 0.01],ICU停留时间[WMD=6.41,95% CI=(5.34,7.47),P0.01]。在50ml/(kg·h)以上治疗剂量的预后对比中,当将低剂量组和高剂量组分别设定为70ml/(kg·h)、≥70ml/(kg·h)时,低剂量组病死率[RR=1.07,95% CI= (0.88,1.31), P=0.48]。结论：35 ml/(kg·h)和≥35 ml/(kg·h)两个剂量组病死率的差异无统计学意义；45 ml/(kg·h)和≥45 ml/(kg·h)两个剂量组的预后比较中,高剂量组可以减少肾功能恢复时间和ICU停留时间,同时可以降低28天的病死率,但不能降低更长观察终点的病死率；在50 ml/(kg·h)以上的比较中,70 ml/(kg·h)和≥70 ml/(kg·h)两个剂量组病死率的差异无统计学意义。因此,脓毒症的CVVH治疗剂量定在45-70 ml/(kg·h)可能比较合理。
[Abstract]:Objective: To evaluate the prognosis of patients with sepsis with different doses of CVVH, and to provide a reference for the clinical determination of the dose of CRRT for sepsis. Methods: Pubmed, Embase, Cochrane electronic retrieval Library, Chinese CNKI, Wan Fang and VIP Chinese 6 journals of science and technology literature database, the search range is from all the literature up to April 2015, in a randomized controlled study involving different doses of CVVH for the treatment of sepsis, according to inclusion and exclusion criteria were screened by the quality evaluation and after data extraction, prognostic index using Review Manager 5.2 software to death received different doses of CVVH treatment in patients with sepsis rate, renal function recovery time, ICU stay time of the statistical analysis of the data, the mortality rate by relative risk (RR) for the effect of volume, renal function recovery time and ICU stay time were weighted by the number of difference (WMD) for the effect of the amount of. Results: a total of 12 papers were included in a randomized controlled study (RCT), with a total of 2343 patients. The Meta analysis results showed that when the low dose group and high dose group were set to 35 ml/ (kg - H), more than 35 ml/ (kg - H), low dose group), 1.27 case fatality rate [RR=1.07,95%CI= 0.91 P=0.40], 14-15 day mortality rate of [RR=1.41,95%CI= (0.80,2.52), P=0.24], 14-30, [RR=1.27,95%CI= (0.99,1.64 day mortality rate), P=0.06], 30-60 DAY mortality rate of [RR=1.13,95%CI= (0.71,1.79), P=0.60], 60-90 day mortality rate of [RR=1.00,95%CI= (0.85,1.19), P=0.98]. When the low dose group and high dose group were set to 45 ml/ (kg - H), more than 45 ml/ (kg - H), low dose group, the fatality rate was [RR=1.24,95%CI= (1.01,1.52), P=0.04], 28 day mortality rate of [RR=1.74,95% CI= (1.01,2.99), P=0.04], 60 day mortality rate of [RR=1.08,95% CI= (0.85,1.36). P=0.53], 28-60 day mortality rate of [RR=1.18,95%CI= (0.95,1.46), P=0.13], 60-90 [RR=1.25,95% CI= day mortality (0.80, 1.97), P=0.32], renal function recovery time (2.68,5.09), [WMD=3.89,95% CI= P 0.01] ICU [WMD=6.41,95% CI=, residence time (5.34,7.47), P0.01]. In 50ml/ (kg, H) in the prognosis compared the above treatment dose, when the low dose group and high dose group were set as 70ml/ (kg, H) = 70ml/ (kg, H), low dose group, the fatality rate was [RR=1.07,95% CI= (0.88,1.31), P=0.48]. Conclusion: 35 ml/ (kg - H) and more than 35 ml/ (kg - H) was not statistically significant two dose mortality differences; 45 ml/ (kg - H) and more than 45 ml/ (kg - H) two prognosis dose group in high dose group can reduce the renal function recovery time and ICU stay time. At the same time can reduce the mortality rate of 28 days, but can not reduce the mortality rate in the longer observation end point; 50 ml/ (kg - H) above comparison, 70 ml/ (kg - H) and more than 70 ml/ (kg - H) was not statistically significant two dose groups of mortality the difference. Therefore, the dosage of CVVH for sepsis at 45-70 ml/ (kg. H) may be more reasonable.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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