目标导向液体治疗在脑肿瘤切除术中应用效果的meta分析

doi:10.3969/j.issn.1004-583X.2023.08.002

摘要/Abstract

摘要：

目的系统评价目标导向液体治疗在脑肿瘤切除术中的应用效果。方法计算机检索Pubmed 、Embase、Cochrane Library、Web of Sicense、VIP、CNKI、WanFang Database、CBM数据库(建库至2022年4月),按照纳入排除标准筛选文献,质量评价并提取相关数据后,采用RevMan5.3软件和Stata SE16.0软件进行Meta分析。结果共纳入17个符合标准的随机对照试验,共计962例患者。 Meta分析结果显示:相比于常规液体组,目标导向组术毕心脏指数(CI)增加[MD=0.45,95%CI(0.36, 0.55),P<0.01],术毕平均动脉压(MBP)升高[MD=6.14,95%CI(4.85,7.44),P<0.01],术中颈静脉球混合血氧饱和度(SjvO₂)增加[切开硬脑膜后1 h:MD=4.77,95%CI(2.58,6.96),P<0.01;术毕:MD=4.42,95%CI(1.21,7.62),P=0.007],术毕血乳酸(Lac)水平降低[MD=-0.57,95%CI(-0.77,-0.37),P<0.01],术后神经功能缺损评分(NIHSS)降低[术后24 h:MD=-2.95,95%CI(-3.85,-2.05),P<0.01],术后简易智能量表(MMES)评分升高[术后1 d:MD=1.12,95%CI(0.26,1.99),P=0.01;术后3 d:MD=1.40,95%CI(0.75,2.05),P<0.01]。结论目标导向液体治疗有助于维持脑肿瘤切除术患者循环稳定,提高组织灌注,改善氧供平衡,减少术后并发症,有利于术后恢复。

关键词: 目标导向液体治疗, 脑肿瘤切除术, meta分析

Abstract:

Objective To systematically evaluate the effect of goal-directed fluid therapy (GDFT) on brain tumor resection. Methods Relevant articles reporting the application of GDFT to brain tumor resection published from the inception to April 2022 were searched in online databases, including the PubMed, Embase, Cochrane Library, Web of Science, VIP database, CNKI, WanFang database, and Chinese Biomedical Database (CBM). Eligible studies were screened according to the inclusion and exclusion criteria. After quality evaluation and extraction of relevant data, RevMan5.3 software and Stata SE16.0 software were used for meta-analysis. Results A total of 17 eligible randomized controlled trials (RCTs) involving 962 patients were included. Meta-analysis results showed that at the end of surgery, patients in GDFT group had increased cardiac index (CI) (MD=0.45; 95%CI: 0.36, 0.55; P<0.01), mean arterial pressure (MAP) (MD=6.14; 95%CI: 4.85, 7.44; P<0.01), and jugular bulb mixed oxygen saturation (SjvO₂) (1 hour after incision of the dura: MD=4.77; 95%CI: 2.58, 6.96; P<0.01; at the end of surgery: MD=4.42; 95%CI: 1.21, 7.62; P=0.007), but significantly lower blood lactate (Lac) (MD=-0.57; 95%CI: -0.77, -0.37; P<0.01) than those of regular fluid group. The postoperative National Institute of Health stroke (NIHSS) score decreased [24 h after surgery: MD=-2.95; 95%CI: -3.85, -2.05; P<0.01), and the postoperative Mini-mental State Examination (MMSE) score increased (1 day after surgery: MD= 1.12; 95%CI: 0.26, 1.99; P=0.01; 3 days after surgery: MD=1.40; 95%CI: 0.75, 2.05; P<0.01) in patients of GDFT group than those of regular fluid group. Conclusion GDFT can maintain hemodynamic stability, improve tissue perfusion, sustain oxygen supply-demand balance, and facilitate postoperative recovery in patients undergoing brain tumor resection.

Key words: goal-directed fluid therapy, brain tumor resection, meta-analysis

中图分类号:

R739.41

侯有玲, 李奕, 关红玉, 罗红霞. 目标导向液体治疗在脑肿瘤切除术中应用效果的meta分析[J]. 临床荟萃, 2023, 38(8): 686-693.

Hou Youling, Li Yi, Guan Hongyu, Luo Hongxia. Effect of goal-directed fluid therapy on brain tumor resection: A systematic review and meta-analysis[J]. Clinical Focus, 2023, 38(8): 686-693.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.08.002

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I8/686

图/表 13

图1 纳入文献筛选流程图

Fig. 1 Flow chart of included literature screening

表1 纳入研究基本特征

Tab. 1 Basic characteristics of the eligible studies

纳入研究	年龄(岁)		样本量(例)		监测指标	结局指标
纳入研究	目标导向液体组	常规液体组	目标导向液体组	常规液体组	监测指标	结局指标
Hasanin 2019^[12]	41±12	39±13	31	30	PPV>13	⑤
Mishra 2022^[13]	44±12.6	39±11	20	20	SVV>12	①②⑤
伍淑韫 2020^[14]	18~65		30	30	PPV>13	②⑤
吴洁 2017^[15]	50±9	50±9	33	30	SVV>12	⑤
张杰 2012^[16]	42±12	42±10	20	20	SVV>13	①②⑤
易勇 2016^[17]	53±4.8	52.5±4.9	53	53	SVV>13	②④⑤⑥
潘晓燕 2017^[18]			58	57	ITBVI:800~1000 ml/m²	③④⑦⑧
王学飞 2016^[19]	39.6±3.6	40.1±4.2	27	25	SVV>12	①②③④
王德勇 2019^[20]	60.13±12.31	60.21±12.24	25	25	ITBVI:800~1000 ml/m²	⑤⑥
王慧霞 2021^[21]	40.96±2.29	41.87±2.42	48	47	SVV>13	②⑧
田胜兰 2015^[22]	54.7±4.2	52.5±6.3	12	12	SVV>12	①②③④
莫朴 2015^[23]	43.2±9.7		40	40	ITBVI:800~1000 ml/m²	②⑥
袁柳青 2013(心指数)^[24]	18~60		14	12	ITBVI:800~1000 ml/m²	①⑥
袁柳青 2013(脑氧代谢)^[25]	47.3±11.1	49.8±10.3	14	12	ITBVI:800~1000 ml/m²	③④⑤
袁柳青 2020(vigileo 监测)^[26]	47.1±11.2	45.3±12.4	20	20	SVV>13	⑦⑧
袁柳青 2020(基于每博变异)^[27]	46.4±8.2	45.7±8.1	23	23	SVV>13	①②⑦⑧
赵晓生 2019^[28]			19	19	SVV>13	⑦⑧

图2 纳入研究风险评估

Fig. 2 Risk assessment of eligible studies

图3 两组术毕CI分析

Fig. 3 CI analysis in the two groups at the end of operation

图4 两组术毕MBP分析

Fig. 4 MBP analysis in the two groups at the end of operation

图5 切开硬脑膜后1h的SjvO2分析

Fig. 5 SjvO2 analysis 1 hour after incision of the dura

图6 术毕SjvO2分析

Fig. 6 SjvO2 analysis at the end of operation

图7 两组术毕Lac

Fig. 7 Lac of two groups at the end of operation

图8 术后NIHSS评分

Fig. 8 Postoperative NIHSS score

图9 术后1 d MMES评分

Fig. 9 MMES score at 1 day postoperatively

图10 术后3 d MMES评分

Fig. 10 MMES score at 3 days postoperatively

图11 漏斗图

Fig. 11 Funnel plot

图12 敏感性分析 a.切开1 h SjvO2;b.术毕SjvO2; c.术毕Lac;d.术后1 d MMES评分;e.术后3 d MMES评分

Fig. 12 Sensitivity analysis a.SjvO2 1 hour after incision of the dura;b. SjvO2 at the end of operation; c.Lac at the end of operation; d.MMES score at 1 day postoperatively;e. MMES score at 3 days postoperatively

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