Mapstone James, Roberts Ian, Evans Phillip
Public Health Medicine, Castle Point and Rochford Primary Care Trust, Rayleigh, Essex, United Kingdom.
J Trauma. 2003 Sep;55(3):571-89. doi: 10.1097/01.TA.0000062968.69867.6F.
Our objective was to systematically review randomized, controlled trials of fluid resuscitation in animal models of uncontrolled hemorrhage and to explore potential sources of heterogeneity.
We conducted an electronic bibliographic search of published research, reviewed reference lists of included trials, and contacted authors about unpublished studies. We included all unconfounded, randomized, controlled trials of fluid resuscitation (timing, volume, or resuscitation targets) in animal models of uncontrolled hemorrhage. The outcome measure was mortality at the end of the scheduled follow-up period of the trial. Two reviewers independently applied the selection criteria to the trial reports. A third reviewer resolved disagreements.
Forty-four trials compared fluid versus no fluid resuscitation. There was marked heterogeneity in the effect of fluid resuscitation on the risk of death, much of which was explained by the hemorrhage model used. In aortic injury models, the adjusted relative risk of death with fluid resuscitation was 0.48 (95% confidence interval [CI], 0.33-0.71). In organ incision models, the adjusted relative risk of death was 0.76 (95% CI, 0.49-1.18). In tail resection models, the adjusted relative risk of death was 0.69 (95% CI, 0.38-1.25) if 50% or more was removed and 1.86 (95% CI, 1.13-3.07) if less than 50% was removed. In other vascular injury models, the adjusted relative risk of death with fluid resuscitation was 1.70 (95% CI, 1.01-2.85), respectively. Nine trials compared hypotensive versus normotensive resuscitation. The relative risk of death with hypotensive resuscitation was 0.37 (95% CI, 0.27-0.50).
Fluid resuscitation appears to reduce the risk of death in animal models of severe hemorrhage but increases the risk of death in those with less severe hemorrhage. Excessive fluid resuscitation could therefore be harmful in some situations. Hypotensive resuscitation reduced the risk of death in all the trials investigating it. An evaluation of the potential impact of hypotensive resuscitation in humans could now be warranted.
我们的目的是系统评价在未控制出血动物模型中进行液体复苏的随机对照试验，并探究潜在的异质性来源。
我们对已发表的研究进行了电子文献检索，查阅了纳入试验的参考文献列表，并就未发表的研究与作者进行了联系。我们纳入了所有在未控制出血动物模型中进行液体复苏（时机、容量或复苏目标）的无混杂因素的随机对照试验。结局指标为试验预定随访期结束时的死亡率。两名研究者独立将纳入标准应用于试验报告。第三名研究者解决分歧。
44项试验比较了液体复苏与未进行液体复苏的情况。液体复苏对死亡风险的影响存在显著异质性，其中大部分可由所使用的出血模型解释。在主动脉损伤模型中，液体复苏的校正死亡相对风险为0.48（95%置信区间[CI]，0.33 - 0.71）。在器官切开模型中，校正死亡相对风险为0.76（95%CI，0.49 - 1.18）。在尾部切除模型中，如果切除50%或更多，校正死亡相对风险为0.69（95%CI，0.38 - 1.25）；如果切除少于50%，则为1.86（95%CI，1.13 - 3.07）。在其他血管损伤模型中，液体复苏的校正死亡相对风险分别为1.70（95%CI，1.01 - 2.85）。9项试验比较了低血压复苏与正常血压复苏。低血压复苏的死亡相对风险为0.37（95%CI，0.27 - 0.50）。
液体复苏似乎可降低严重出血动物模型的死亡风险，但会增加出血程度较轻动物模型的死亡风险。因此，在某些情况下过度液体复苏可能有害。低血压复苏在所有研究其的试验中均降低了死亡风险。现在有必要评估低血压复苏对人类的潜在影响。
