人工和生物人工支持系统急性和急性-慢性肝衰竭:一个系统的审查
Lise L Kjaergard1, Jianping Liu, Bodil Als-Nielsen
1The Cochrane Hepato-Biliary Group, The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, H:S Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. kjaergard@ctu.rh.dk
JAMA
|January 9, 2003
概括
人工支持系统在减少急性-慢性肝衰竭的死亡率方面表现有前途. 然而,这些系统在急性肝衰竭病例中没有显著影响生存率.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 生物医学工程 生物医学工程
- 临界护理医学 临界护理医学
背景情况:
- 严重的肝病需要先进的治疗方法,如人工和生物人工支持系统.
- 这些系统可以作为恢复或肝移植的关键桥梁.
- 评估它们的有效性对于患者管理至关重要.
研究的目的:
- 评估人工和生物人工支持系统对患者结果的影响.
- 重点是患有急性肝衰竭和急性至慢性肝衰竭的患者.
主要方法:
- 随机对照试验 (RCT) 和非随机研究的系统审查和元分析.
- 搜索包括主要的数据库,直到2002年9月,补充了书目和专家联系人.
- 所有原因的死亡率是主要的结果指标,使用随机效应模型进行分析.
主要成果:
- 包括12项涉及483名患者的RCT,10项专注于人工系统,2项专注于生物人工系统.
- 总的来说,与标准医学治疗相比,支持系统没有显著改变死亡率 (RR,0.86;95% CI,0.65-1.12).
- 分层分析显示,在急性-慢性肝衰竭 (RR,0.67;95% CI,0.51-0.90) 中,支持系统显著降低了死亡率 (33%),但在急性肝衰竭 (RR,0.95;95% CI,0.71-1.29) 中没有.
结论:
- 人工支持系统显示出降低死亡率的潜力,特别是在急性-慢性肝衰竭中.
- 目前的证据表明,这些系统不会显著影响急性肝衰竭的死亡率.
- 进一步的研究可能是有必要的,以探索不同类型的肝衰竭中支持系统有效性的细微差别.
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