摘要
目的 系统评价局部枸橼酸钠抗凝在血液滤过患者中的应用效果。方法 计算机检索中国知网、万方数据库、维普数据库、PubMed、EMbase、CBM，追溯纳入文献和相关综述文献，收集关于局部枸橼酸钠抗凝与低分子肝素抗凝用于血液滤过患者应用效果的随机对照试验（RCT）及回顾性分析。实验组采用局部枸橼酸钠抗凝，对照组采用低分子肝素抗凝。检索时间建库至2021年5月1日，根据纳入与排除标准筛选文献、提取资料。结局指标：出血事件、滤器使用时间、活化部分凝血激酶时间（APTT）、钠离子（Na+）、钙离子（Ca2+）、酸碱度（pH）、血肌酐（Scr）、C反应蛋白（CRP）、发表偏倚。结果 共纳入11项研究，共939例血液滤过患者，其中应用局部枸橼酸钠抗凝实验组455例和低分子肝素抗凝对照组484例。Meta分析结果显示，与对照组相比，实验组能明显提高血液滤过患者滤器使用时间（Z=27.23，P<0.001），降低出血事件发生率（Z=4.23，P<0.001）、APTT水平（Z=15.53，P<0.001）、游离Na+水平（Z=3.95，P<0.001）、Scr水平（Z=8.32，P<0.001）和CRP水平（Z=15.87，P<0.001），游离Ca2+水平（Z=0.19，P=0.85）和pH水平（Z=1.55，P=0.12）无统计学差异。结论 与低分子肝素抗凝比较，局部枸橼酸钠抗凝效果更好，可有效降低出血事件发生率，延长滤器使用寿命，减轻炎症反应，改善机体凝血功能，值得推广。
关键词： 血液滤过；局部枸橼酸钠抗凝；出血事件；凝血功能；Meta分析
Abstract
Objective To systematically evaluate the effect of topical sodium citrate anticoagulation in patients with hemofiltration. Methods CNKI, Wanfang database, VIP database, PubMed, EMbase, CBM were searched by computer, and the included literatures and related review literatures were retrospectively included. Randomized controlled trials (RCTs) and retrospective analysis on the efficacy of topical sodium citrate anticoagulation versus low molecular weight heparin anticoagulation in hemofiltration patients were collected. The experimental group was treated with local sodium citrate anticoagulation, and the control group was treated with low molecular weight heparin. The retrieval period will be established until May 1, 2021. Two researchers screened the literature according to the inclusion and exclusion criteria, and extracted data to evaluate the risk of bias in the included studies. Main outcome indicator: bleeding events, filter use time, activated partial thromboplastin time, sodium ion, calcium ion, pH, creatinine, C-reactive protein, publication bias. Results A total of 11 studies were included, including 455 patients treated with topical sodium citrate anticoagulation and 484 patients treated with low molecular weight heparin anticoagulation. The results of meta-analysis showed that compared with the control group, the experimental group significantly increased the use time of the filter in hemofiltration patients (Z=27.23, P<0.001), reduced the incidence of bleeding events (Z=4.23, P<0.001), and reduced the level of APTT (Z=15.53, P<0.001), free Na+ levels (Z=3.95, P<0.001), Scr levels (Z=8.32, P<0.001) and CRP levels (Z=15.87, P<0.001), free Ca2+ levels (Z=0.19, P=0.85) and pH levels (Z=1.55, P=0.12) there was no statistical difference. Conclusion Compared with low molecular weight heparin anticoagulation, local sodium citrate has better anticoagulation effect, can effectively reduce the incidence of bleeding events, prolong the service life of filters, reduce inflammatory response, and improve the coagulation function of the body, which is worthy of promotion.
Key words： Hemofiltration; Topical sodium citrate anticoagulation; Bleeding events; Coagulation function; Meta-analysis
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