连续性血液滤过治疗急性重症胰腺炎的Meta分析

目的评价连续性静脉-静脉血液滤过(CVVH)治疗急性重症胰腺炎的有效性和安全性。方法应用计算机检索电子数据库:PubMed(1980～2011年)、中国期刊全文数据库(CNK:1990～2011年)、万方数据库(1980～2011年),并手工检索Cochrane图书馆。采用Cochrane系统评价员手册4.2.2推荐的方法纳入文献,并对其进行Meta分析。结果共有12篇文章纳入研究。共纳入383例患者,其中CVVH治疗者(CVVH组)208例,常规非手术治疗者(对照组)175例。对12个研究进行了Meta分析。结果显示:与常规非手术组相比,CVVH组明显提高了总体治愈率OR=3.24,95%CI(1.69,6.22),P=0.0004],降低了总体病死率OR=0.32,95%CI(0.15,0.68),P=0.003],缩短了腹痛、腹胀症状改善时间,降低了并发症发生率。结论根据目前证据,早CVVH治疗SAP患者可能是安全有效的。目前所获研究仅来自中国且方法学质量较低,需要进一步开展高质量大样本的RCT来评价CV-VH治疗SAP有效性和安全性。

Meta analysis of CVVH for severe acute pancreatitis

Objective To evaluate the effect and safety of CVVH in patients with severe acute pancreatitis(SAP). Methods Computer-based online search of PubMed(1980～2011),CNKI(1990～2011) and CHINAINFO(1980～2011) were performed to collect related articles.In addition,Cochrane library was manually searched.Literature was included in accordance with Cochrane systematic review guidline 4.2.2.Meta analysis was performed to evaluate the data. Results A total of 12 articles were accordance with the criteria,involving 383 cases,including 208 cases of CVVH and 175 cases of ordinary non-operation treatment.Meta analysis of 12 studies showed that CVVH significantly increased the overall cure rate OR=3.24,95%CI(1.69,6.22),P=0.0004 ] and decreased the overall mortality rate OR=0.32,95%CI(0.15,0.68),P=0.003].Moreover,the duration of abdominal pain or distension were shortened,and the incidence of complications of SAP reduced significantly compared with the ordinary non-operation treatment. Conclusion Based on the above evidence,early CVVH was effective and safe for SAP.Gurrent studies were only available form china and poor in methodological quality,so further high-quality,large-scale,randomized controlled trails are required to identify the effectiveness and safety of early CVVH for SAP.