明胶对心胸外科老年患者围术期肾功能影响的Meta分析

目的应用Meta分析研究围术期输入大剂量明胶(>33ml/kg)对心胸外科老年患者(>60岁)肾功能的影响。方法以Medline电子数据库作为主要资料来源,整理原始文件并摘录相关数据,对血清肌酐(SCr)的相关数据采用固定效应模型,对围术期输液量采用随机效应模型,然后进行加权均数差(WMD)计算,并对结果进行z检验。结果共8篇文献满足纳入标准。心胸外科老年患者围术期输入大剂量明胶后Cr与术前相比差异有统计学意义(P<0.01)(WMD=0.20mg/dL,95%CI为0.15～0.25)。但和输入大剂量HES相比,两者的Cr变化没有统计学差异(P=0.76)(WMD=-0.01mg/dL,95%CI为-0.07～0.05)。在术中明胶组需要输入更多的胶体量来保证扩容效果。结论围术期对心胸外科老年患者输入大剂量明胶可能加重肾功能损害。但和HES相比没有统计学差异。

Meta-analysis on effect of renal function after perioperative infusion of high dose gelatin on elderly patients undergoing cardiac surgery

Objective To investigate the effects of high dose gelatin(>33ml/kg) infusion on renal function in elderly patients(>60 years old) undergoing cardiac surgery. Methods A systematic review of the literatures was performed in the electronic data base of Medline.The citations were unscrambled and the data were recorded.Weighted mean differences(WMD) of the data on the serum creatintine(SCr) were tested using the fixed effect model and the perioperative infusion amount was tested using the random effect model.Z test was performed to examine their reliability. Results Eight citations were involved in this study.After high dose gelatin infusion in elderly patients undergoing cardiac surgery,the SCr level increased significantly after surgery(P<0.01)(WMD=0.20 units,95%CI 0.15,0.25).Compared with importing high dose HES to the elderly patients undergoing cardiac surgery,there were no statistics difference between gelatin and HES(P=0.76)(WMD=-0.01 units,95%CI为-0.07~0.05).More amount of gelatin was needed to support the normal circulation perioperatively. Conclusions Perioperative infusion of high dose gelatin may aggravate the renal dysfunction in elderly patients undergoing cardiac surgery,but there is no statistics difference between gelatin and HES.