本文關鍵詞：不同劑量CVVH治療膿毒癥患者預后的meta分析　出處：《廣西醫(yī)科大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： CVVH 血液凈化 膿毒癥 劑量 meta分析

【摘要】：目的：系統(tǒng)評價不同劑量CVVH治療膿毒癥患者的預后,為臨床確定膿毒癥的CRRT治療劑量提供參考。方法：電子檢索Pubmed、Embase、Cochrane Library、中國知網、萬方和維普中文科技期刊6個文獻數(shù)據(jù)庫,搜索范圍是從建庫至2015年4月的所有文獻,納入涉及不同劑量CVVH治療膿毒癥的隨機對照研究,根據(jù)納入標準和排除標準篩選文獻,經質量評價及提取數(shù)據(jù)后,使用Review Manager 5.2軟件對接受不同劑量CVVH治療的膿毒癥患者的病死率、腎功能恢復時間、ICU停留時間等預后指標進行數(shù)據(jù)統(tǒng)計分析,病死率采用相對危險度(RR)為效應量,腎功能恢復時間及ICU停留時間采用加權均數(shù)差(WMD)為效應量。結果：納入隨機對照研究(RCT)文獻12篇,共有2343位患者。Meta分析結果顯示當將低劑量組和高劑量組分別設定為35 ml/(kg·h)、≥ 35 ml/(kg·h)時,低劑量組病死率[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]。當將低劑量組和高劑量組分別設定為45 ml/(kg·h)、≥45 ml/(kg·h)時,低劑量組病死率[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],腎功能恢復時間[WMD=3.89,95% CI=(2.68,5.09),P 0.01],ICU停留時間[WMD=6.41,95% CI=(5.34,7.47),P0.01]。在50ml/(kg·h)以上治療劑量的預后對比中,當將低劑量組和高劑量組分別設定為70ml/(kg·h)、≥70ml/(kg·h)時,低劑量組病死率[RR=1.07,95% CI= (0.88,1.31), P=0.48]。結論：35 ml/(kg·h)和≥35 ml/(kg·h)兩個劑量組病死率的差異無統(tǒng)計學意義；45 ml/(kg·h)和≥45 ml/(kg·h)兩個劑量組的預后比較中,高劑量組可以減少腎功能恢復時間和ICU停留時間,同時可以降低28天的病死率,但不能降低更長觀察終點的病死率；在50 ml/(kg·h)以上的比較中,70 ml/(kg·h)和≥70 ml/(kg·h)兩個劑量組病死率的差異無統(tǒng)計學意義。因此,膿毒癥的CVVH治療劑量定在45-70 ml/(kg·h)可能比較合理。
[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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.7

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