高容量血液滤过治疗对感染性休克患者预后的荟萃分析

目的 评价高容量血液滤过(HVHF)及其治疗时机对感染性休克患者预后的影响.方法 通过计算机检索和手工检索全面收集国内外1999至2009年关于高容量血液滤过治疗感染性休克的随机对照试验(RCT)、病例对照研究及观察性前瞻性队列研究,按Cochrane协作网推荐的方法对HVHF治疗感染性休克的病死率作荟萃评价.结果 纳入4项对照性研究、5项前瞻性队列研究.4项对照性研究(3项RCT、1项病例对照研究)共167例感染性休克患者被纳入,包括HVHF组79例,传统剂量治疗组88例.HVHF组和传统剂量治疗组病死率分别为40.5%(32/79)和72.7%(64/88),与传统剂量治疗组比较,HVHF能降低感染性休克患者病死率[OR 0.33,(95%CI,0.17～0.64);P＜0.01].5项前瞻性队列研究共观察了 HVHF对170例感染性休克患者病死率的影响,荟萃分析显示HVHF能降低病死率[OR 0.31,(95%CI,0.19～0.49);P＜0.01],与对照研究结果一致.仅2项研究探讨了HVHF治疗时机对感染性休克病死率的影响,虽然这两项研究的早期HVHF治疗组病死率均低于晚期HVHF治疗组,但研究的异质性显著(P＜0.05),不宜作荟萃分析.结论 高容量血液滤过治疗可降低感染性休克患者的病死率,但是受研究方法的限制,有必要进行更多大样本、高质量的随机对照试验.

Effects of high volume hemofiltration on mortality in patients with septic shock: a meta-analysis

Objective To evaluate the effect of high volume hemofiltration (HVHF) and its therapeutic timing on mortality in patients with septic shock. Methods Randomized controlled trials (RCT), case-control studies and prospective cohort studies on HVHF treating septic shock patients from 1999 to 2009 were identified by electronic and manually retrieving related data. An Meta-analysis of HVHF on mortality in septic shock patients was conducted through the methods recommended by the Cochrane Collaboration. Results 3 RCTs, 1 case-control study and 5 prospective cohort studies were selected. A total of 167 cases in 4 studies (3 RCTs, 1 case-control study) involving 79 HVHF and 88 LVHF groups were included for a Meta-analysis. The mortalities of septic shock in HVHF and LVHF groups were 40. 5%(32/79) and 72. 7% (64/88) respectively. As compared with traditional LVHF, HVHF could reduce the mortality in patients with septic shock [OR 0. 33, (95% CI,0. 17-0. 64); P ＜0. 01]. For 170 patients with septic shock in 5 prospective cohort studies, their mortality rates were improved by HVHF [OR 0. 31,(95% CI, 0. 19-0. 49); P ＜ 0. 01]. It was consistent with the results of 4 control studies. Only 2 studies indicated the early HVHF group versus the late HVHF group could improve the survival of septic shock.Since there was significant heterogeneity between them ( P ＜ 0. 05 ), it was better not to perform a Metaanalysis. Conclusion There is a beneficial effect of high volume hemofiltration on mortality in septic shock patients. Further studies of a larger sample of high quality RCTs should be carried out to guide its use.