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中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (01) : 39 -45. doi: 10.3877/cma.j.issn.2096-1537.2019.01.008

所属专题: 重症营养 文献

重症医学研究

呼气末闭塞试验预测容量反应性价值的系统回顾及Meta分析:基于国际数据库的结果
高明1, 周华1,(), 郭喆1, 吴圣1, 许媛1   
  1. 1. 102218 北京,清华大学附属北京清华长庚医院重症医学科 清华大学临床医学院
  • 收稿日期:2018-01-20 出版日期:2019-02-28
  • 通信作者: 周华

End-expiratory occlusion test for predicting fluid responsiveness: a systematic review and meta-analysis based on international databases

Ming Gao1, Hua Zhou1,(), Zhe Guo1, Sheng Wu1, Yuan Xu1   

  1. 1. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine Tsinghua University, Beijing 102218, China
  • Received:2018-01-20 Published:2019-02-28
  • Corresponding author: Hua Zhou
  • About author:
    Corresponding author: Zhou Hua, Email:
引用本文:

高明, 周华, 郭喆, 吴圣, 许媛. 呼气末闭塞试验预测容量反应性价值的系统回顾及Meta分析:基于国际数据库的结果[J]. 中华重症医学电子杂志, 2019, 05(01): 39-45.

Ming Gao, Hua Zhou, Zhe Guo, Sheng Wu, Yuan Xu. End-expiratory occlusion test for predicting fluid responsiveness: a systematic review and meta-analysis based on international databases[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(01): 39-45.

目的

通过系统回顾以及Meta分析评价呼气末闭塞试验(EEOT)判定容量反应性的临床价值。

方法

通过计算机检索PubMed、Embase、Cochrane Library数据库,收集自建库至2017年10月所有应用EEOT评价容量反应性的临床研究,由2位研究员独立进行文献筛选、资料提取及方法学质量评价。采用双变量混合效应模型对其敏感度、特异度、阳性似然比、阴性似然比及诊断比值比进行合并分析,同时绘制受试者工作特征曲线图,并计算曲线下面积(AUC);绘制Fagan图,评价其临床应用价值。此外,进一步筛选同时采用EEOT与脉压变异性(PPV)分别判断容量反应性的研究,计算相对诊断比值比,评价两种方法对容量反应性的预测价值。

结果

共纳入7篇文献,共计270次容量评估,均以液体负荷试验作为评价容量反应性的金标准。EEOT判断容量反应性的合并敏感度和特异度分别为0.93(95%CI:0.86~0.96)、0.90(95%CI:0.81~0.95),ROC的AUC为0.97(95%CI:0.95~0.98)。7篇文献中共4篇同时比较EEOT、PPV的容量预测价值,EEOT与PPV的相对诊断比值比为3.13(P=0.24)。

结论

EEOT预测容量反应性有较高的敏感度以及特异度,其预测价值可能不低于PPV,但仍需要前瞻性的大样本研究进一步证实。

Objective

To determine the predictive value of the end-expiratory occlusion test (EEOT) in fluid responsiveness evaluation by performing a systematic review and meta-analysis of studies.

Methods

Databases including PubMed, Embase and Cochrane Database were searched for relevant clinical trials before October 2017. Two independent investigators extracted data and study characteristics. Bivariate mixed-effects regression model was used to estimate the pooled sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio with 95% CIs. The SROC curve and Fagan graphs were produced, and the area under the curve was also calculated. Meanwhile, we calculated relative diagnostic odds ratio (RDOR) to compare diagnostic value of EEOT and PPV.

Results

Seven studies (260 adult patients, 270 fluid challenges) were included. Fluid challenge test was used as standard reference in all studies. For the EEOT-induced changes in CO or its surrogate, the pooled sensitivity was 0.93 (95%CI: 0.86-0.96) and the pooled specificity was 0.90 (95%CI: 0.81-0.95). The area under the ROC curve was 0.97 (95%CI: 0.95-0.98). Four studies which compared EEOT and PPV at the same time, the RDOR was 3.13 (P=0.24).

Conclusion

EEOT-induced changes in CO or its surrogate can very reliably predict the response of CO to volume expansion in adult patients. There is no significant difference between the diagnostic value of EEOT and PPV.

图1 文献筛选流程图
表1 纳入文献基本特征
表2 纳入文献EEOT特征
表3 纳入文献液体负荷试验特征
图2 QUADAS-2质量评价结果
图3 呼气末闭塞试验评价容量反应性的Deek′s漏斗图
图4 呼气末闭塞试验评价容量反应性的合并敏感度和特异度
图5 EEOT评价容量反应性的SROC曲线图
图6 EEOT评价容量反应性的似然比点状图
图7 呼气末闭塞试验评价容量反应性的Fagan图
图8 EEOT、PPV评价容量反应性的SROC图
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