血流动力学不稳定骨盆骨折的止血干预与全因死亡率：一项系统评价与荟萃分析
Hemostatic Interventions and All-Cause Mortality in Hemodynamically Unstable Pelvic Fractures: A Systematic Review and Meta-Analysis.
作者信息
Zheng XuWen, Chen MaoBing, Zhuang Yi, Xu Jin, Zhao Liang, Qian YongJun, Shen WenMing, Chu Ying
机构信息
Truama Center Wujin People's Hospital Affiliated with Jiangsu University and Wujin Clinical College of Xuzhou Medical University, Changzhou 213017, China.
Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Changzhou 213017, China.
出版信息
Emerg Med Int. 2024 Aug 26;2024:6397444. doi: 10.1155/2024/6397444. eCollection 2024.
OBJECTIVE
To conduct a systematic review and meta-analysis of the all-cause mortality associated with the most commonly used hemostatic treatments in patients with hemodynamically unstable pelvic fractures.
METHODS
Up to April 30, 2023, we searched PubMed, Embase, Web of Science, and Cochrane, including the references to qualified papers. A meta-analysis was performed on studies that reported odds ratios (ORs) or the number of events needed to calculate them. The PROSPERO registration number was CRD42023421137.
RESULTS
Of the 3452 titles identified in our original search, 29 met our criteria. Extraperitoneal packing (EPP) (OR = 0.626 and 95% CI = 0.413-0.949), external fixation (EF) (OR = 0.649 and 95% CI = 0.518-0.814), and arterial embolism (AE) (OR = 0.459 and 95% CI = 0.291-0.724) were associated with decreased mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) (OR = 2.824 and 95% CI = 1.594-5.005) was associated with increased mortality. A random effect model meta-analysis of eight articles showed no difference in mortality between patients with AE and patients with EPP for the initial treatments for controlling blood loss (OR = 0.910 and 95% CI = 0.623-1.328).
CONCLUSION
This meta-analysis collectively suggested EF, AE, or EPP as life-saving procedures for patients with hemodynamically unstable pelvic fractures.
目的
对血流动力学不稳定的骨盆骨折患者中最常用的止血治疗方法与全因死亡率进行系统评价和荟萃分析。
方法
截至2023年4月30日，我们检索了PubMed、Embase、Web of Science和Cochrane数据库，包括合格论文的参考文献。对报告比值比（OR）或计算这些比值比所需事件数的研究进行荟萃分析。PROSPERO注册号为CRD42023421137。
结果
在我们最初检索到的3452个标题中，有29个符合我们的标准。腹膜外填塞（EPP）（OR = 0.626，95%可信区间[CI] = 0.413 - 0.949）、外固定（EF）（OR = 0.649，95% CI = 0.518 - 0.814）和动脉栓塞（AE）（OR = 0.459，95% CI = 0.291 - 0.724）与死亡率降低相关。主动脉内球囊阻断复苏术（REBOA）（OR = 2.824，95% CI = 1.594 - 5.005）与死亡率增加相关。对八篇文章进行的随机效应模型荟萃分析显示，在控制失血的初始治疗中，AE患者和EPP患者的死亡率没有差异（OR = 0.910，95% CI = 0.623 - 1.328）。
结论
这项荟萃分析共同表明，EF、AE或EPP是血流动力学不稳定的骨盆骨折患者的救命措施。
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