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目的:评价甘露醇用于急性肾损伤高风险患者的预防效果。方法:检索英文数据库Pub Med,EMBASE,Cochrane Controlled Trials Register和Clinical Trials,收集应用甘露醇预防急性肾损伤效果的研究数据,检索时间均从建库至2015年11月7日。由2名评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价并交叉核对后,采用Rev Man 5.3进行Meta分析。结果:共纳入13项随机对照研究的867例患者。Meta分析结果表明,甘露醇组在预防血肌酐(MD=0.39,95%CI:-0.46~4.83,I2=61%,P=0.86)、肌酐清除率(MD=-5.86,95%CI:-12.04~0.33,I2=0%,P=0.06)和尿量(MD=3.45,95%CI:-5.38~12.28,I2=42%,P=0.44)3个肾功能指标的恶化方面与对照组没有显著差异。预防药物(顺铂、造影剂)诱导的急性肾损伤,对照组的水化效果更佳(MD=14.67,95%CI:6.99~22.35,I2=0%,P=0.000 2)。对于行心脏手术的患者,甘露醇组预防术后6 h尿量减少的效果可能优于对照组(RR=35.90,95%CI:0.66~71.13,I2=0%,P=0.05)。甘露醇组的急性肾损伤发生率和/或透析需要率明显更低(MD=0.50,95%CI:0.33~0.75,I2=49%,P=0.000 8)。结论:在充分水化的基础上应用甘露醇不会带来额外的获益。甘露醇不能有效预防肾毒性药物(顺铂、造影剂)导致的肾功能恶化。但甘露醇对于术后6 h内尿量的改善可能优于对照组,且甘露醇组的急性肾损伤发生率和/或透析需要率明显更低。仍需大规模、高质量的随机对照研究进一步证实以上结论。
Objective: To evaluate the preventive effect of mannitol in high-risk acute kidney injury patients. Methods: The databases of Pub Med, EMBASE, Cochrane Controlled Trials Register and Clinical Trials were searched and the data of mannitol in prevention of acute renal injury were collected. The search time was from the database to November 7, 2015. Two reviewers independently performed literature screening, data extraction, and quality evaluation based on inclusion and exclusion criteria, and cross-checked them, using a meta-analysis of Rev Man 5.3. Results: A total of 13 randomized controlled trials of 867 patients were included. The result of Meta analysis showed that the creatinine clearance rate (MD = -5.86, 95% CI: - There was no significant difference between the two groups in the progression of renal function (P> 0.05), and the control group (P = 0.012) No significant difference. Acute renal injury induced by prophylactic drugs (cisplatin, contrast medium) showed better hydration in the control group (MD = 14.67, 95% CI: 6.99-22.35, I2 = 0%, P = 0.0002). In patients undergoing cardiac surgery, the effect of mannitol in preventing postoperative urinary output reduction at 6 hours was better than that of the control group (RR = 35.90, 95% CI: 0.66-71.13, I2 = 0%, P = 0.05). The incidence of acute kidney injury and / or dialysis in the mannitol group was significantly lower (MD = 0.50, 95% CI: 0.33-0.75, I2 = 49%, P = 0.0008). Conclusion: The application of mannitol on the basis of adequate hydration offers no additional benefit. Mannitol can not effectively prevent renal function deterioration caused by nephrotoxic drugs (cisplatin, contrast agent). However, mannitol may improve the urine output within 6 h after operation, and the incidence of acute kidney injury and / or dialysis in the mannitol group is significantly lower. Still need large-scale, high-quality randomized controlled studies to further confirm the above conclusions.