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在儿科败血症中,平衡晶体与同位素盐水相比:综合系统性综述和元分析
Asmaa Mhanna1, Azizullah Beran2, Omar Srour3
1Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Proceedings (Baylor University. Medical Center)
|February 12, 2024
概括
与同位素盐溶液 (IS) 相比,平衡晶体 (BC) 在儿科败血症中显著降低死亡率和急性损伤 (AKI). 虽然住院时间 (LOS) 总体上没有差异,但BC在RCT中显示出好处.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 流体复苏策略 流体复苏策略
- 败血症的管理管理.
背景情况:
- 儿科败血症是一种危及生命的疾病,需要迅速和适当的液体复苏.
- 同位素盐水 (IS) 是传统的液体,但人们对其潜在的不良影响存在担忧.
- 平衡晶体 (BC) 提供了具有更生理性的电解质组成的替代性液体复苏选项.
研究的目的:
- 进行全面的元分析,比较BC与IS在儿科败血症中的疗效和安全性.
- 评估BC和IS对关键临床结果的影响,包括死亡率,急性损伤 (AKI) 和停留时间 (LOS).
主要方法:
- 系统的文献搜索比较儿童败血症患者的BC和IS的研究.
- 包括六项涉及8753名儿童的研究.
- 使用随机效应模型计算聚合几率比率 (OR) 和平均差异 (MD) 以95%的置信区间 (CI).
主要成果:
- 与IS相比,BC使用与总死亡率 (OR 0.84,95% CI 0.71-0.98) 和AKI (OR 0.74,95% CI 0.57-0.96) 的显著降低有关.
- 两组之间对需要置换疗法 (RRT) 或整体医院/PICU LOS的需要没有显著差异.
- 随机对照试验 (RCT) 的子组分析表明,BC的医院LOS显著较短 (MD -0.66天,95%CI -1.10至 -0.23).
结论:
- 均衡晶体 (BC) 在儿科败血症中表现出有利的特征,与同位素盐水 (IS) 相比,与降低死亡率和AKI相关.
- 住院和PICU停留时间 (LOS) 在流体组之间是可比的,尽管RCT表明BC的医院LOS较短.
- 需要进一步的大规模随机对照试验来最终验证这些发现,并完善液体复苏指南.
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