白蛋白作为复苏液体对脓毒症患者预后影响的荟萃分析

目的 通过比较白蛋白与其他液体对脓毒症患者复苏结果的影响,评估白蛋白液体复苏是否可以降低脓毒症患者病死率.方法 通过检索美国《医学索引》(MEDLINE)、生物医学与药理学文摘数据库(Embase)、Cochrane临床试验数据库、对照试验Meta注册(the metaRegister of Controlled Trials)、医学编辑试验拾遗注册(the Medical Editors Trial Amnesty Register).寻找比较含白蛋白液体复苏和其他液体复苏的随机对照临床试验(RCT)的相关文献.纳入研究人群为确诊脓毒症的成人患者,及包括脓毒症患者作为亚组的相关研究.用RevMan 5.0软件对纳入研究进行荟萃分析(Meta分析),主要结局指标是所有住院患者的病死率.结果 共纳入14项RCT,包括1729例患者接受了白蛋白或其他液体复苏.其中5项研究仅纳入脓毒症,另9项研究将脓毒症作为亚组.P=0.98,I2=0％,没有异质性,故使用固定效应模型合并结果.应用含白蛋白相关液体对脓毒症患者进行复苏与其他液体复苏相比病死率无明显差异[优势比(OR)为0.87,95％可信区间(95％CI)0.71～1.07,P=0.18];其中高浓度白蛋白(20％)溶液复苏合并OR为1.11,95％CI0.71～1.73,P=0.65,低浓度白蛋白(4％、5％)溶液复苏合并OR为0.82,95％CI 0.65～1.03,P=0.09,不同浓度白蛋白溶液复苏与总体研究结果一致.本研究分别剔除了Boldt等人的6篇研究及生理盐水和白蛋白液体复苏评价(SAFE)研究后再进行敏感性分析,用以检测这些数据对总结果是否产生决定性意义,剔除7篇文献之后总结果没有变化(剔除Boldt等的研究:OR 0.82,95％CI0.65～1.02,P=0.08;剔除SAFE研究:OR 1.05,95％CI0.71～1.55,P=0.82),分析结果是稳健的.结论 脓毒症患者使用含白蛋白液体复苏与其他种类液体复苏相比没有降低病死率.

Influence of albumin as a resuscitation fluid on the prognosis of patients with sepsis: a Meta-analysis

Objective To compare the effect of albumin as a resuscitation fluid with other fluids in lowering the mortality of patients with sepsis.Methods By searching MEDLINE,Embase,Cochrane Central Registration of Controlled Trials databases,the metaRegister of Controlled Trials,the Medical Editors Trial Amnesty Register,and retrieval of the randomized controlled trial (RCT) literature to compare the result of resuscitation using albumin-containing fluid and other fluids.The study population included adult patients who were diagnosed to have sepsis,and the patients with sepsis who were studied as subgroup.The RevMan 5.0 software was used for Meta-analysis,and the main outcome was the mortality of the hospitalized patients.Results In the 14 RCTs,1729 patients received the albumin-containing fluid resuscitation or resuscitation with other fluids.It was found that the patients with sepsis were the only research objects in five studies,and in other nine studies patients with sepsis were studied as subgroup.P=0.98,I2=0％,i.e.no heterogenicity,and the fixed effect model was used for combining results.There was no evident difference between the group of patients with sepsis resuscitated by albmin-containing fluids and other fluids [odds ratio (OR) was 0.87,95％ confidence interval (95％CI) 0.71-1.07,P=0.18].The pooled OR of resuscitation using high concentration albumin solution (20％) was 1.11,95％CI 0.71-1.73,P=0.65,the pooled OR of resuscitation using low concentration albumin solution (4％,5％ ) was 0.82,95％CI 0.65-1.03,P=0.09.Resuscitation with different concentration of albmin-containing fluids was identical with the whole research results.After rejecting six articles of Boldt and other authors,and also saline versus albumin fluid evaluation (SAFE) study,the sensitivity analysis of the study was performed in order to check whether the data produced decisive significance to the whole research results or not.The whole results did not change after their rejection( Boldt studies were rejected: OR 0.82,95 ％ CI 0.65 - 1.02,P=0.08; SAFE study was rejected: OR 1.05,95 ％ CI 0.71-1.55,P=0.82 ).Therefore the analysis results were satisfactory.Conclusion The Meta-analysis shows that by using albmin-containing fluids for resuscitation can not lower the mortality of sepsis as compared with other fluids.