血液净化治疗深度烧伤的疗效和安全性：系统评价和荟萃分析。

Efficacy and safety of blood purification in the treatment of deep burns: A systematic review and meta-analysis.

机构信息

Department of Burn and Injury.

Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China.

出版信息

Medicine (Baltimore). 2021 Feb 5;100(5):e23968. doi: 10.1097/MD.0000000000023968.

DOI:10.1097/MD.0000000000023968

PMID:33592850

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7870217/

Abstract

INTRODUCTION

This meta-analysis aimed to systematically review and evaluate randomized controlled trials (RCTs) and cohort studies examining the efficacy and safety of blood purification in the treatment of patients with deep burns.

METHODS

The PubMed, Cochrane Library, and Embase databases and relevant references were systematically searched for RCTs and cohort studies published until the end of September 2020 to investigate the potential of blood purification in improving the prognosis of severely burned patients. The primary outcome of this systematic review was overall patient mortality; secondary outcomes included the incidence of sepsis and infection prevention (vital signs and routine blood tests).

RESULTS

A total of 6 RCTs and 1 cohort study were included, with a total of 538 burn patients (274 patients who received blood purification and 264 control patients). Compared with patients who received conventional treatment, those treated with blood purification displayed significant 2-day reduction in mortality and sepsis with relative risks of 0.62 and 0.41, respectively (95% confidence intervals [CIs], 0.74-0.82 and 0.25-0.67, respectively; P < .05). In terms of vital signs and blood biochemistry, the respiratory rates and blood urea nitrogen levels of patients in the blood purification group 3 days post-treatment were significantly higher than those in the control group (randomized standard deviations (SMDs), 0.78 and 0.77, respectively; 95% CIs, 0.33-1.23 and 1.22-0.31, respectively; P < .05). However, there were no significant differences between groups on day 3 with regard to temperature (P = .32), heart rate (P = .26), white blood cell count (P = .54), or neutrophil count (P = .74), potentially owing to the small sample size or the relatively short intervention time. Heterogeneous differences existed between the groups with respect to blood urea nitrogen (SMD = -1.22; 95% CI, -2.16 to -0.40; P < .00001) and Cr (SMD = -3.13; 95% CI, -4.92 to -1.33; P < .00001) on day 7. No systematic adverse events occurred.

CONCLUSIONS

Blood purification treatment for deep burn patients can significantly reduce the mortality rate and the incidence of complications.

摘要

简介

本荟萃分析旨在系统地回顾和评估随机对照试验（RCT）和队列研究，以评估血液净化治疗深度烧伤患者的疗效和安全性。

方法

系统检索 PubMed、Cochrane 图书馆和 Embase 数据库以及截至 2020 年 9 月底的相关参考文献，以调查血液净化在改善严重烧伤患者预后方面的潜力。本系统评价的主要结局是总体患者死亡率；次要结局包括脓毒症和感染预防（生命体征和常规血液检查）的发生率。

结果

共纳入 6 项 RCT 和 1 项队列研究，共纳入 538 例烧伤患者（接受血液净化治疗的 274 例患者和 264 例对照组患者）。与接受常规治疗的患者相比，接受血液净化治疗的患者在第 2 天死亡率和脓毒症发生率分别显著降低，相对风险分别为 0.62 和 0.41（95%置信区间[CI]，0.74-0.82 和 0.25-0.67；P<0.05）。就生命体征和血液生化学而言，血液净化组患者在治疗后第 3 天的呼吸频率和血尿素氮水平明显高于对照组（随机标准偏差[SMD]，分别为 0.78 和 0.77；95%CI，0.33-1.23 和 1.22-0.31；P<0.05）。然而，在第 3 天，两组之间的体温（P=0.32）、心率（P=0.26）、白细胞计数（P=0.54）或中性粒细胞计数（P=0.74）均无显著差异，这可能是由于样本量较小或干预时间相对较短。在第 7 天，血液尿素氮（SMD=-1.22；95%CI，-2.16 至-0.40；P<0.00001）和肌酐（SMD=-3.13；95%CI，-4.92 至-1.33；P<0.00001）方面存在组间异质性差异。未发生系统性不良事件。