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目的系统评价高渗盐水在脓毒症、脓毒性休克液体复苏中的安全性。方法计算机检索Pub Med、EMBASE、Cochrane图书馆、中国知网和万方数据库,收集应用高渗盐水进行脓毒症、脓毒性休克液体复苏的随机对照试验,检索时限均为从建库至2016-07月。由2位研究者独立根据纳入与排除标准筛选文献、提取资料并对所纳入研究的方法学质量进行评价后,应用Revman 5.3.5软件进行Meta分析。结果共纳入5个研究,包含208例患者。Meta分析结果显示:高渗盐水组与0.9%生理盐水组28 d死亡率[RR=1.02,95%CI(0.79,1.32),P=0.86]、早期目标导向治疗(early goal-directed therapy,EGDT)达标率[RR=1.11,95%CI(0.94,1.31),P=0.22]、升压药物使用情况[RR=1.01,95%CI(0.89,1.16),P=0.84]、升压药物使用超过3 d情况[RR=0.95,95%CI(0.76,1.20),P=0.68]无统计学差异;但高渗盐水组输液量明显低于0.9%生理盐水组[MD=-1 097.90,95%CI(-1 295.26,-900.53),P<0.000 01]。结论高渗盐水液体复苏在28 d死亡率、EGDT达标率和升压药物使用方面同0.9%生理盐水比较无统计学差异,但高渗盐水组总液体输入量明显低于生理盐水组。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the safety of hypertonic saline in sepsis and septic shock fluid resuscitation. Methods PubMed, EMBASE, Cochrane Library, CNKI and Wanfang Computer were searched by computer. Randomized controlled trials of hypertonic saline for sepsis and septic shock fluid recovery were performed. The search time ranged from database construction to 2016- July. Two researchers independently screened the literature based on inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Meta-analysis was performed using Revman 5.3.5 software. Results A total of 5 studies were included, including 208 patients. Meta-analysis showed that the 28-day mortality rate in hypertonic saline group and 0.9% saline group [RR = 1.02, 95% CI 0.79,1.32, P = 0.86], early goal-directed therapy ) (RR = 1.11, 95% CI (0.94, 1.31), P = 0.22], the use of antihypertensive drugs [RR = 1.01,95% CI (0.89,1.16), P = 0.84] No significant difference was found after 3 days (RR = 0.95,95% CI (0.76,1.20), P = 0.68]; however, the infusion volume in hypertonic saline group was significantly lower than 0.9% saline group [MD = -1.097.90,95 % CI (-1 295.26, -900.53), P <0.000 01]. Conclusion There was no significant difference in 28 d mortality rate, EGDT compliance rate and the use of antihypertensive drugs compared with that of 0.9% saline solution, but the total liquid input of hypertonic saline group was significantly lower than that of saline group. Subject to the limitations on the quantity and quality of the studies, the above conclusion still needs to be verified by more high-quality studies.