中国循证医学杂志

中国循证医学杂志

肝素治疗吸入性肺损伤动物实验的系统评价

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目的 系统评价肝素治疗吸入性肺损伤动物实验的模型构建过程及其治疗效果。 方法 计算机检索 PubMed、EMbase、CBM、CNKI、VIP 和 WanFang Data 数据库,搜集肝素治疗吸入性肺损伤的动物实验,检索时限均为建库至 2016 年 11 月。由 2 位研究者独立进行文献筛选、资料提取和偏倚风险评价后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 9 个研究,涉及 11 个吸入性肺损伤动物实验组。纳入研究以羊或大鼠为实验动物,均在 40℃ 以下环境通过棉质毛巾或松木屑燃烧产生烟雾吸入构建模型。Meta 分析结果显示:实验组与对照组的病死率差异无统计学意义[肝素组 vs. 对照组:RR=0.38,95%CI(0.14,1.05),P=0.06;肝素+DMSO 组 vs. DMSO 组:RR=0.10,95%CI(0.01,1.51),P=0.10]。此外,实验组的肺动脉压[MD=–3.31,95%CI(–4.51,–2.11),P<0.000 01]、肺湿干比[MD=–0.90,95%CI(–1.19,–0.61),P<0.000 01]、肺含水量[MD=–1.18,95%CI(–1.67,–0.70),P<0.000 01]均低于对照组;实验组 12 h 氧合指数[MD=131.00,95%CI(59.54,202.46),P=0.000 3]、24 h 氧合指数[MD=114.00,95%CI(60.56,167.44),P<0.000 1]和 48 h 氧合指数[MD=46.00,95%CI(20.62,71.38),P=0.000 4]均高于对照组,且差异均具有统计学意义;但两组凝血功能差异无统计学意义。 结论 当前证据表明,吸入性肺损伤动物模型构建尚缺乏规范方法,肝素治疗吸入性肺损伤动物可降低动物的肺动脉压和肺含水量。受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

Objective To systematically review the effectiveness and model building process of heparin treatment for animal model with smoke inhalation injury. Methods Databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect animal experiments about the treatment of heparin for animal model with smoke inhalation injury from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of nine studies involving 11 animal experiments were included. The results showed that building animal model with smoke inhalation injury were through burning of cotton towels or pine sawdust by sheep or rats below 40℃. The results of meta-analysis showed that there was no significant difference in mortality rate between two groups (heparin group vs. control group: RR=0.38, 95%CI 0.14 to 1.05, P=0.06; heparin plus DMSO group vs. DMSO group: RR=0.10, 95%CI 0.01 to 1.51, P=0.10). In addition, the pulmonary artery pressure (MD=–3.31, 95%CI –4.51 to –2.11, P<0.000 01), wet to dry weight ratio (MD=–0.90, 95%CI –1.19 to –0.61, P<0.000 01), and lung water content (MD=–1.18, 95%CI –1.67 to –0.70, P<0.000 01) of the experimental group were lower than those in the control group. PaO2/FiO2 after 12 hours (MD=131.00, 95%CI 59.54 to 202.46, P=0.000 3), PaO2/FiO2 after 24 hours (MD=114.00, 95%CI 60.56 to 167.44, P<0.000 1), PaO2/FiO2 after 48 hours (MD=46.00, 95%CI 20.62 to 71.38, P=0.000 4) were higher than those in the control group. However, there was no significant difference in coagulation function between both groups. Conclusion The current evidence shows that the establishment of animal model of smoke inhalation injury is still lack of standard method. Heparin can decrease pulmonary artery pressure and lung water content in animal models with smoke inhalation injury. Due to the limited quality and quantity of included studies, the above conclusions are still needed to be verified by more high quality studies.

关键词: 肝素; 吸入性肺损伤; 动物实验; Meta 分析; 系统评价; SYRCLE

Key words: Heparin; Smoke inhalation injury; Animal experiments; Meta-analysis; Systematic review; SYRCLE

引用本文: 田方圆, 吴斌, 徐珽. 肝素治疗吸入性肺损伤动物实验的系统评价. 中国循证医学杂志, 2017, 17(6): 705-710. doi: 10.7507/1672-2531.201612047 复制

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