碳酸氢钠治疗代谢性酸中毒危重症患者：范围界定和系统评价。

Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.

机构信息

Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.

出版信息

J Crit Care. 2019 Jun;51:184-191. doi: 10.1016/j.jcrc.2019.02.027. Epub 2019 Feb 26.

DOI:10.1016/j.jcrc.2019.02.027

PMID:30852347

Abstract

PURPOSE

We aimed to assess the biochemical and physiological effects, clinical efficacy, and safety, of intravenous NaHCO3 therapy in critically ill patients with acute metabolic acidosis.

METHODS

We conducted a scoping review concerning the biochemical and physiological effects of NaHCO3 (PART A), and a systematic review regarding clinical efficacy (PART B). We searched MEDLINE in Part A and MEDLINE, EMBASE, Cochrane, the National Institute of Health Clinical Trials Register, and the WHOICTRP for randomised controlled trials in Part B.

RESULTS

Twelve studies in Part A and two trials in Part B fulfilled the eligibility criteria. Intravenous NaHCO3 increased blood pH, base excess, serum bicarbonate, sodium, and PaCO2 during and after administration and decreased anion gap and potassium value. For clinical efficacy, only one study contributed to the effect estimate. The risk ratio (RR) for all-cause mortality was 0.83 (95% confidence interval, 0.68 to 1.02), and the risk of hypocalcaemia was increased in the bicarbonate group (RR 1.65, 95% confidence interval 1.09 to 2.50). There were inadequate data on hemodynamic indices.

CONCLUSIONS

Given the lack of data on the effects of intravenous NaHCO3 therapy to support its clinical use and the frequency of bicarbonate therapy, a program of investigation appears justified.

摘要

目的

我们旨在评估静脉内碳酸氢钠治疗急性代谢性酸中毒危重症患者的生化和生理效应、临床疗效和安全性。

方法

我们就碳酸氢钠的生化和生理效应进行了范围界定综述（A 部分），并就临床疗效进行了系统综述（B 部分）。我们在 A 部分中检索了 MEDLINE，在 B 部分中检索了 MEDLINE、EMBASE、Cochrane、美国国立卫生研究院临床试验登记处和世界卫生组织国际临床试验注册平台，以寻找随机对照试验。

结果

A 部分有 12 项研究和 B 部分有 2 项试验符合入选标准。静脉内碳酸氢钠在给药期间和之后增加了血液 pH 值、碱剩余、血清碳酸氢盐、钠和 PaCO2，降低了阴离子间隙和钾值。对于临床疗效，只有一项研究对效应估计有贡献。全因死亡率的风险比（RR）为 0.83（95%置信区间，0.68 至 1.02），碳酸氢盐组发生低钙血症的风险增加（RR 1.65，95%置信区间 1.09 至 2.50）。关于血流动力学指标的数据不足。