碳酸氢钠治疗危重症患者代谢性酸中毒：随机对照试验的贝叶斯系统评价与荟萃分析。
完整摘要 · 中文译文
目的：评估碳酸氢钠治疗对代谢性酸中毒危重成人患者死亡率和肾脏结局的影响。 方法：我们开展了一项系统评价和贝叶斯随机效应荟萃分析，纳入比较静脉碳酸氢钠与安慰剂或常规治疗在成人重症监护病房代谢性酸中毒患者中应用的随机对照试验（RCT）。检索了MEDLINE、Embase和CENTRAL数据库，检索时间自建库至2025年12月，并于2026年4月2日更新检索。主要结局为短期全因死亡率。次要结局包括启动肾脏替代治疗（RRT）、90天死亡率、无RRT天数、无血管活性药物天数、重症监护病房和住院时长以及不良事件。 结果：共分析4项RCT，纳入1544例患者。碳酸氢钠未显示出明确的短期死亡率获益（RR 0.94，95% CrI 0.73-1.22），获益的后验概率为72.1%。对于启动RRT，碳酸氢钠与较低风险相关（RR 0.74，95% CrI 0.59-0.98），获益的后验概率为97.2%。对其他结局的影响较小或不精确，未发现一致的安全性信号。 结论：现有随机证据未证明碳酸氢钠治疗对代谢性酸中毒危重成人患者具有明确的生存获益，但提示其降低RRT启动的概率较高。进一步试验应明确最可能获益的患者人群。PROSPERO注册号：CRD420251246519。
完整摘要 · 英文原文
PURPOSE: To evaluate the effects of sodium bicarbonate therapy on mortality and renal outcomes in critically ill adults with metabolic acidosis. METHODS: We performed a systematic review and Bayesian random-effects meta-analysis of randomised controlled trials (RCTs) comparing intravenous sodium bicarbonate with placebo or usual care in adult intensive care unit patients with metabolic acidosis. MEDLINE, Embase and CENTRAL were searched from inception to December 2025, with an updated search on 2 April 2026. The primary outcome was short-term all-cause mortality. Secondary outcomes included renal replacement therapy (RRT) initiation, 90-day mortality, RRT-free days, vasopressor-free days, intensive care unit and hospital length of stay and adverse events. RESULTS: Four RCTs including 1544 patients were analysed. Sodium bicarbonate did not show a clear short-term mortality benefit (RR 0.94, 95% CrI 0.73-1.22), with a posterior probability of benefit of 72.1%. For RRT initiation, sodium bicarbonate was associated with a lower risk (RR 0.74, 95% CrI 0.59-0.98), with a posterior probability of benefit of 97.2%. Effects on other outcomes were small or imprecise, and no consistent safety signal was identified. CONCLUSION: Current randomised evidence does not demonstrate a clear survival benefit from sodium bicarbonate therapy in critically ill adults with metabolic acidosis, but suggests a high probability of reducing RRT initiation. Further trials should define the patients most likely to benefit. PROSPERO registration: CRD420251246519.