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

  更多相關(guān)文章： CVVH 血液凈化 膿毒癥 劑量 meta分析

【摘要】：目的：系統(tǒng)評(píng)價(jià)不同劑量CVVH治療膿毒癥患者的預(yù)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(wǎng)、萬方和維普中文科技期刊6個(gè)文獻(xiàn)數(shù)據(jù)庫,搜索范圍是從建庫至2015年4月的所有文獻(xiàn),納入涉及不同劑量CVVH治療膿毒癥的隨機(jī)對(duì)照研究,根據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)篩選文獻(xiàn),經(jīng)質(zhì)量評(píng)價(jià)及提取數(shù)據(jù)后,使用Review Manager 5.2軟件對(duì)接受不同劑量CVVH治療的膿毒癥患者的病死率、腎功能恢復(fù)時(shí)間、ICU停留時(shí)間等預(yù)后指標(biāo)進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,病死率采用相對(duì)危險(xiǎn)度(RR)為效應(yīng)量,腎功能恢復(fù)時(shí)間及ICU停留時(shí)間采用加權(quán)均數(shù)差(WMD)為效應(yīng)量。結(jié)果：納入隨機(jī)對(duì)照研究(RCT)文獻(xiàn)12篇,共有2343位患者。Meta分析結(jié)果顯示當(dāng)將低劑量組和高劑量組分別設(shè)定為35 ml/(kg·h)、≥ 35 ml/(kg·h)時(shí),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(dāng)將低劑量組和高劑量組分別設(shè)定為45 ml/(kg·h)、≥45 ml/(kg·h)時(shí),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(fù)時(shí)間[WMD=3.89,95% CI=(2.68,5.09),P 0.01],ICU停留時(shí)間[WMD=6.41,95% CI=(5.34,7.47),P0.01]。在50ml/(kg·h)以上治療劑量的預(yù)后對(duì)比中,當(dāng)將低劑量組和高劑量組分別設(shè)定為70ml/(kg·h)、≥70ml/(kg·h)時(shí),低劑量組病死率[RR=1.07,95% CI= (0.88,1.31), P=0.48]。結(jié)論：35 ml/(kg·h)和≥35 ml/(kg·h)兩個(gè)劑量組病死率的差異無統(tǒng)計(jì)學(xué)意義；45 ml/(kg·h)和≥45 ml/(kg·h)兩個(gè)劑量組的預(yù)后比較中,高劑量組可以減少腎功能恢復(fù)時(shí)間和ICU停留時(shí)間,同時(shí)可以降低28天的病死率,但不能降低更長(zhǎng)觀察終點(diǎn)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(gè)劑量組病死率的差異無統(tǒng)計(jì)學(xué)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(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.7

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本文編號(hào)：1346888