Wilkes M M, Navickis R J, Sibbald W J
Hygeia Associates, Grass Valley, California 95949, USA.
Ann Thorac Surg. 2001 Aug;72(2):527-33; discussion 534. doi: 10.1016/s0003-4975(01)02745-x.
This meta-analysis tested the hypothesis that cumulative blood loss during the first 24 hours after cardiopulmonary bypass is lower in patients exposed to albumin than hydroxyethyl starch (HES).
Randomized controlled trials comparing albumin and HES in cardiopulmonary bypass patients were identified by bibliographic database searches and other methods.
Sixteen trials involving 653 randomized patients were included. In 88% of randomized comparisons, postoperative bleeding was lower in the albumin group, and the standardized mean difference in bleeding favoring albumin across all trials (-0.24; 95% confidence interval, -0.40 to -0.08) was statistically significant. Bleeding differences between albumin and either high or medium molecular weight HES were similar. In trials of adults, the pooled mean blood loss in the albumin group was 693+/-350 mL compared with 789+/-487 mL in the HES group. The estimated proportion of adult albumin group patients with blood loss of more than 1,000 mL was 19% compared with 33% of adult HES group patients. Conclusions. Postoperative blood loss is significantly lower in cardiopulmonary bypass patients exposed to albumin than HES.
本荟萃分析检验了以下假设：在体外循环后最初24小时内，接受白蛋白治疗的患者累积失血量低于接受羟乙基淀粉（HES）治疗的患者。
通过文献数据库检索及其他方法，确定了比较体外循环患者中白蛋白和HES的随机对照试验。
纳入了16项试验，涉及653例随机分组患者。在88%的随机对照比较中，白蛋白组术后出血较少，所有试验中有利于白蛋白的出血标准化平均差为-0.24（95%置信区间，-0.40至-0.08），具有统计学意义。白蛋白与高分子量或中分子量HES之间的出血差异相似。在成人试验中，白蛋白组的合并平均失血量为693±350ml，而HES组为789±487ml。估计白蛋白组失血量超过1000ml的成年患者比例为19%，而HES组成年患者为33%。结论：体外循环患者接受白蛋白治疗后的术后失血量显著低于接受HES治疗的患者。
