摘要
目的系统评价不同液体疗法预防剖宫产麻醉低血压的有效性。方法计算机检索PubMed、EMBase、Cochrane library、中国知网、万方数据、维普数据库及临床试验注册网站,检索范围为建库至2020年10月,纳入剖宫产围手术期应用不同液体疗法的随机对照试验(RCTs)。2名研究员独立筛选文献、提取数据及评估纳入研究的偏倚风险。采用RevMan5.4版软件进行直接Meta分析,并采用RStudio1.3.1093版软件gemtc程序包进行网状Meta分析。结果共纳入RCTs100项,剖宫产患者8911例,6种液体(3种晶体注射液:普通林格注射液、乳酸林格注射液、醋酸林格注射液,3种胶体注射液:羟乙基淀粉注射液、明胶注射液、右旋糖酐注射液)及0.9%氯化钠注射液作为对照。网状Meta分析结果显示各液体疗法降低剖宫产麻醉低血压发生率有效性依次为:右旋糖酐注射液、羟乙基淀粉注射液、明胶注射液、醋酸林格注射液、乳酸林格注射液和普通林格注射液。但不同液体疗法纳入研究数量差异较大,且纳入研究总体质量不高。结论基于当前证据,胶体注射液预防剖宫产麻醉低血压疗效优于晶体注射液,右旋糖酐注射液和醋酸林格注射液分别为胶体注射液和晶体注射液中的优选品种。还应结合患者过敏史和肾功能等选择液体品种。
Objective To systematically evaluate the efficacy of different fluid therapies in preventing hypotension during anesthesia for cesarean section.Methods We searched databases and clinical trial websites including PubMed,EMBase,Cochrane library,CNKI,Wanfang and VIP.The researches were collected from database establishment to October 2020.We gathered randomized controlled trials(RCTs)of fluid therapy in preventing hypotension during anesthesia for cesarean section.Two researchers screened literature,extracted study data,and independently assessed the risk of bias of included RCTs.We employed RevMan software(version 5.4)for direct meta-analysis,and RStudio software(version 1.3.1093)with the GeMTC program package for network meta-analysis.Results We finally gathered a total of 100 RCTs,including 8911 recipients,and six kinds of fluid therapies.Three kinds of crystalloid solutions included normal Ringer's injection,lactate Ringer's injection,and acetate Ringer's injection.And three kinds of colloid solutions included hydroxyethyl starch injection,gelatin injection and dextran injection.Moreover,0.9%sodium chloride injection was selected as a control intervention.The network meta-analysis indicated that efficacy for preventing hypotension was ordered as followed:dextran injection,hydroxyethyl starch injection,gelatin injection,acetate Ringer's injection,lactate Ringer's injection,and normal Ringer's solution.However,the number of included studies varied from different solutions,and the quality of included studies was low.Conclusion Based on current evidence,colloid injection was superior to crystalloid injection in preventing hypotension during anesthesia for cesarean section.The preferred selection was dextran injection for colloid injection,and acetate Ringer's injection for crystalloid injection.Moreover,patient's allergy history and renal function should also be considered in fluid therapy selection.
作者
李丹
杨甜
占美
陈晨
吴斌
徐珽
LI Dan;YANG Tian;ZHAN Mei;CHEN Chen;WU Bin;XU Ting(Department of Pharmacy,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Pharmacy,Women and Children's Hospital of Chongqing Medical University,Chongqing 400021,China;Department of Pharmacy,Chongqing Health Center for Women and Children,Chongqing 400021,China;West China School of Pharmacy,Sichuan University,Chengdu 610041,China)
出处
《医药导报》
CAS
北大核心
2022年第11期1681-1693,共13页
Herald of Medicine
基金
四川大学华西医院技术服务项目(HX-H1907151)。
