限制液体复苏不仅对失血性休克有益，对感染性休克也有益吗？一项荟萃分析。

Is restrictive fluid resuscitation beneficial not only for hemorrhagic shock but also for septic shock?: A meta-analysis.

机构信息

Graduate School.

Department of Emergency Medicine, Zhongshan Hospital, Dalian University, Dalian, China.

出版信息

Medicine (Baltimore). 2021 Mar 26;100(12):e25143. doi: 10.1097/MD.0000000000025143.

DOI:10.1097/MD.0000000000025143

PMID:33761680

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9282070/

Abstract

BACKGROUND

Whether to use limited fluid resuscitation (LFR) in patients with hemorrhagic shock or septic shock remains controversial. This research was aimed to assess the pros and cons of utilizing LFR in hemorrhagic shock or septic shock patients.

METHODS

PubMed, Cochrane Library, Embase, Web of science, CNKI, VIP, and Wan Fang database searches included for articles published before December 15, 2020. Randomized controlled trials of LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients were selected.

RESULT

This meta-analysis including 28 randomized controlled trials (RCTs) and registered 3288 patients. The 7 of 27 RCTs were the patients with septic shock. Others were traumatic hemorrhagic shock patients. Comparing LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients, the summary odds ratio (OR) was 0.50 (95% confidence interval [CI] 0.42-0.60, P < .00001) for mortality, 0.46 (95% CI 0.31-0.70, P = .0002) for multiple organ dysfunction syndrome (MODS), 0.35 (95% CI 0.25-0.47) for acute respiratory distress syndrome (ARDS), and 0.33 (95% CI 0.20-0.56) for disseminated intravascular coagulation (DIC).

CONCLUSION

Limited fluid resuscitation is the benefit of both traumatic hemorrhagic shock patients and septic shock patients.

摘要

背景

在失血性休克或感染性休克患者中，是否采用限制液体复苏（LFR）仍存在争议。本研究旨在评估在失血性休克或感染性休克患者中采用 LFR 的利弊。

方法

检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、VIP 和万方数据库，纳入 2020 年 12 月 15 日前发表的 LFR 或充分液体复苏治疗失血性休克或感染性休克患者的随机对照试验。

结果

本 meta 分析纳入 28 项随机对照试验（RCT），共注册 3288 例患者。其中 7 项 RCT 的患者为感染性休克，其余为创伤性失血性休克患者。与 LFR 或充分液体复苏相比，失血性休克或感染性休克患者的汇总优势比（OR）为 0.50（95%置信区间[CI] 0.42-0.60，P<0.00001），死亡率为 0.46（95%CI 0.31-0.70，P=0.0002），多器官功能障碍综合征（MODS）发生率为 0.35（95%CI 0.25-0.47），急性呼吸窘迫综合征（ARDS）发生率为 0.33（95%CI 0.20-0.56），弥散性血管内凝血（DIC）发生率为 0.33（95%CI 0.20-0.56）。