Hypotensive resuscitation for traumatic hemorrhagic shock: a systematic review / 中华急诊医学杂志

ABSTRACT

Objective To systematically review the efficacy of hypotensive resuscitation for traumatic-hemorrhagic shock.Methods Randomized controlled trails (RCTs) or quasi-Randomized controlled trails (qRCTs) were searched in Pubmed,Embase and the Corchrane Library from inception to August 2015.Two reviewers respectively picked out the useful data and performed quality evaluation.Metaanalysis was carried out with RevMan 5.3 software,risk ratio (RR) and its 95％ confidence interval (CI) were pooled to estimate the enumeration data,and GRADE 3.6.1 software was used to rate the level of evidence.Results The results of meta-analysis and GRADE rating system which included 4 studies showed thatcompared with conventional resuscitation,hypotensive resuscitation was associated with lower total mortality [RR =0.77,95％ CI0.62-0.95,P =0.01;n =984,GRADE ratingmoderate],and 24-hour mortality [RR =0.47,95％ CI0.24-0.91,P =0.03;n =281,GRADE ratingmoderate],but the subgroup analysis of total mortality showed that there were no significant differences in mortality between the subgroup of blunt or penetrating trauma and the subgroup of penetrating trauma.Conclusions Hypotensive resuscitation reduced total mortality and 24-hour mortality,and the quality of the evidence was moderate.The future studies should do further research to explore the efficacy of hypotensive resuscitation for different types of trauma.