零平衡超滤对体外循环术后恢复的影响：一项随机对照试验的荟萃分析

The effects of zero-balance ultrafiltration on postoperative recovery after cardiopulmonary bypass: a meta-analysis of randomized controlled trials.

作者信息

Zhu X, Ji B, Wang G, Liu J, Long C

机构信息

Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

出版信息

Perfusion. 2012 Sep;27(5):386-92. doi: 10.1177/0267659112450182. Epub 2012 Jun 7.

DOI:10.1177/0267659112450182

PMID:22677632

Abstract

OBJECTIVE

Considered as a significant ultrafiltration technology during cardiopulmonary bypass (CPB), zero-balance ultrafiltration (Z-BUF) has always received controversial support regarding its effectiveness in reducing inflammatory mediators in plasma. Therefore, we conducted a meta-analysis to evaluate the clinical effect of Z-BUF through screening all relevant published randomized controlled trials (RCTs).

METHODS

A comprehensive search was conducted to screen all RCTs of Z-BUF. Three trained investigators searched databases, including PubMed, Embase, the Cochrane Library, Google scholar, and Chinese literature databases (CNKI, WanFang, WeiPu). RCTs that compared Z-BUF with non-ultrafiltration were included. We focused on clinical outcomes such as length of stay in ICU, duration of ventilation, hospital stay, total amount of chest tube drainage and mortality. Finally, a total of 7 studies containing appropriate criteria were divided into an adult group and a pediatric group. A random effects model was used to calculate weighted mean difference with 95% confidence intervals.

RESULTS

In the adult group, the benefits of Z-BUF in duration of ventilation (WMD=-2.77, 95% CI = [-6.26, 0.72], I(2)=71%, p=0.12) and the length of ICU stay (WMD=-4.13, 95% CI = [-10.09, 1.84], I(2)=77%, Z=1.36, p=0.17) were not apparent, with significant heterogeneity existing in the statistical results. The rest of the clinical parameters could not be evaluated due to insufficient data. In the pediatric group, combined analysis showed Z-BUF could reduce the duration of mechanical ventilation (WMD=3.07; 95%CI= [-7.56, -3.46], I(2)=17%, p=0.27). The advantage of Z-BUF was not observed in other clinical outcomes.

CONCLUSION

The benefits of Z-BUF were not apparent, according to the report. Further studies involving combined ultrafiltration are expected to provide improved ultrafiltration during CPB.

摘要

目的

零平衡超滤（Z-BUF）被视为体外循环（CPB）期间一项重要的超滤技术，但其在降低血浆炎症介质方面的有效性一直存在争议。因此，我们通过筛选所有相关的已发表随机对照试验（RCT）进行荟萃分析，以评估Z-BUF的临床效果。

方法

进行全面检索以筛选所有Z-BUF的RCT。三名经过培训的研究人员检索了多个数据库，包括PubMed、Embase、Cochrane图书馆、谷歌学术以及中国文献数据库（知网、万方、维普）。纳入比较Z-BUF与非超滤的RCT。我们关注的临床结局包括重症监护病房（ICU）住院时间、通气时间、住院时间、胸管引流量总量及死亡率。最后，共有7项符合适当标准的研究被分为成人组和儿童组。采用随机效应模型计算加权平均差及95%置信区间。

结果

在成人组中，Z-BUF在通气时间（加权平均差=-2.77，95%置信区间=[-6.26, 0.72]，I²=71%，p=0.12）和ICU住院时间（加权平均差=-4.13，95%置信区间=[-10.09, 1.84]，I²=77%，Z=1.36，p=0.17）方面的益处不明显，统计结果存在显著异质性。由于数据不足，其余临床参数无法评估。在儿童组中，综合分析显示Z-BUF可缩短机械通气时间（加权平均差=3.07；95%置信区间=[-7.56, -3.46]，I²=17%，p=0.27）。在其他临床结局中未观察到Z-BUF的优势。