本文選題：夜間透析　切入點(diǎn)：長(zhǎng)時(shí)間透析　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:系統(tǒng)評(píng)價(jià)延長(zhǎng)血液透析時(shí)間對(duì)維持性血液透析患者生存率、生活質(zhì)量的影響,為臨床選擇血液透析時(shí)間提供參考。方法:計(jì)算機(jī)在線檢索廣西醫(yī)科大學(xué)圖書(shū)館PumMed、Web of Science、Ebsco、循證醫(yī)學(xué)評(píng)價(jià)數(shù)據(jù)庫(kù)等外文電子數(shù)據(jù)庫(kù)有關(guān)不同血液透析時(shí)間對(duì)維持血液透析患者生存率和生活質(zhì)量影響的臨床試驗(yàn),檢索時(shí)限為建庫(kù)至2017年3月10日。使用RevMam5.3軟件進(jìn)行meta分析。結(jié)果:計(jì)算機(jī)檢索到2個(gè)RCT、2個(gè)PCT、9個(gè)隊(duì)列研究共108523名患者納入本研究。其中11個(gè)研究比較透析時(shí)間4h模式與透析時(shí)間≤4h模式患者死亡率;3個(gè)研究比較了透析時(shí)間4h組與透析時(shí)間≤4h組患者的生活質(zhì)量。Meta分析結(jié)果:(1)透析時(shí)間4h組死亡率低于透析時(shí)間≤4h組(RR 0.7,95%Cl[0.68,0.71],P0.00001)。(2)亞組分析:(I)以透析時(shí)間4h且血流量、透析液流量低的為試驗(yàn)組,以透析時(shí)間≤4h且血流量、透析液流量均高的為對(duì)照組,試驗(yàn)組死亡率低于對(duì)照組(RR 0.75,95%Cl[0.58,0.97],P=0.03)。(II)以透析時(shí)間≥8h為長(zhǎng)時(shí)間組,透析時(shí)間≤4h為短時(shí)間組,兩組患者死亡率差異無(wú)統(tǒng)計(jì)學(xué)意義(RR 0.65,95%Cl[0.21,2.05],P=0.46);對(duì)透析時(shí)間≥8h的研究進(jìn)一步行血流量亞組分析:以透析時(shí)間≥8h、低血流量組為試驗(yàn)組,以透析時(shí)間≤4h、高血流量組為對(duì)照組,試驗(yàn)組死亡率低于對(duì)照組(RR 0.25,95%Cl[0.09,0.65],P=0.004)。(III)以透析時(shí)間為4h且8h組為長(zhǎng)時(shí)間組,透析時(shí)間4h組為短時(shí)間組,長(zhǎng)時(shí)間組死亡率低于短時(shí)間組(RR 0.64,95%Cl[0.63,0.66],P0.00001)。(3)對(duì)生化指標(biāo)及心臟的影響:以透析時(shí)間4h為長(zhǎng)時(shí)間,以透析時(shí)間≤4h為短時(shí)間組,(I)對(duì)血磷的影響:長(zhǎng)時(shí)間組血磷水平低于短時(shí)間組(MD-1.16,95%Cl[-1.39,-0.93],P0.00001);(II)對(duì)血紅蛋白的影響:長(zhǎng)時(shí)間組血紅蛋白水平高于短時(shí)間組(MD 0.34,95%Cl[0.21,0.47],P0.00001);(III)對(duì)血清白蛋白、左心室質(zhì)量指數(shù)的影響:長(zhǎng)時(shí)間組與短時(shí)間組血清白蛋白水平、左心室質(zhì)量指數(shù)無(wú)統(tǒng)計(jì)學(xué)差異(MD 0.07,95%Cl[-0.01,0.15],P=0.09;MD-10.55,95%Cl[-26.23,5.13],P=0.19)。(4)對(duì)生活質(zhì)量的影響:透析時(shí)間4h組在身體狀況總評(píng)分高于透析時(shí)間≤4h組(MD 4.36,95%Cl[3.47,5.26],P0.00001),但在精神總評(píng)分方面,透析時(shí)間4h組與透析時(shí)間≤4組差異無(wú)統(tǒng)計(jì)學(xué)意義(MD 1.84,95%Cl[-3.34,7.03],P=0.49)。結(jié)論:1.低血流量、低透析液流量、透析時(shí)間4h透析模式能提高M(jìn)HD患者生存率,透析時(shí)間以4-8h為宜;2.透析時(shí)間4h透析模式能增加血磷的清除,改善貧血;對(duì)血清白蛋白和左心室質(zhì)量指數(shù)的影響與透析時(shí)間≤4h透析模式無(wú)差異。3.對(duì)生活質(zhì)量的影響:與透析時(shí)間≤4h模式比,透析時(shí)間4h模式更能改善身體狀況總評(píng)分;改善精神總評(píng)分方面,透析時(shí)間4h模式與透析時(shí)間≤4模式無(wú)差異。
[Abstract]:Objective: to evaluate the effect of prolonging hemodialysis time on survival rate and quality of life of maintenance hemodialysis patients. Methods: to search online the library of Guangxi Medical University, PumMeden Web of Science, Ebscol, and other foreign electronic databases, such as Evidence-based Medicine Evaluation Database, on the maintenance of hemodialysis with different hemodialysis time. A clinical trial of the effects of survival and quality of life on dialysis patients, RevMam5.3 software was used to carry out meta analysis. Results: two RCTs, two PCTs, nine cohort studies were retrieved by computer and 108523 patients were included in this study. Among them, 11 studies were compared with 4 hours dialysis time model. Three studies were conducted to compare the quality of life (QOL) between dialysis time group (4h group) and dialysis time group (鈮，

本文編號(hào)：1667213