[Meta-analysis of the curative effect of low molecular weight heparin on acute respiratory distress syndrome].

ABSTRACT

OBJECTIVE: To observe the clinical effect of low molecular weight heparin on the curative effect of acute respiratory distress syndrome (ARDS) patients through a systematic evaluation method. METHODS: Databases such as PubMed, Cochrane Library database, Web of Science, CNKI, China Biological Medical Literature Database (CBM), VIP, Wanfang database were searched to retrieve randomized controlled trials (RCTs) on low molecular weight heparin and conventional treatment on the efficacy and prognosis of patients with acute lung injury (ALI)/ARDS from the establishment of the database to September 2020. The conventional treatment group was given conventional treatment, and the low molecular heparin group was given low molecular heparin based on conventional treatment. Outcome indicators were oxygenation index (PaO2/FiO2), acute physiology and chronic health evaluation II (APACHE II), activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count (PLT), interleukin-6 (IL-6) and the mortality at 7 days and 28 days. The literature was screened according to the proposed inclusion and exclusion criteria; the Cochrane collaboration evaluation tool was used to evaluate the quality of literature; Meta analysis used RevMan 5.3 software to perform funnel plot analysis on the outcome indicators of the included ≥ 11 literatures, and to evaluate the publication bias. RESULTS: A total of 12 RCTs and 623 patients were included. The results of Meta analysis showed that PaO2/FiO2 increased in the low molecular weight heparin group compared with the conventional treatment group [mean difference (MD) = 72.08, 95% confidence interval (95%CI) was 56.92-87.24, P < 0.000 01], APACHE II (MD = -4.34, 95%CI was -5.73 to -2.96, P < 0.000 01), IL-6 [standardized mean difference (SMD) = -2.13, 95%CI was -2.71 to -1.56, P < 0.000 01] and 7-day mortality [relative risk (RR) = 0.52, 95%CI was 0.30-0.90, P = 0.02] and 28-day mortality (RR = 0.55, 95%CI was 0.34-0.90, P = 0.02) were significantly reduced, APTT was significantly shortened (MD = -0.88, 95%CI was -1.51 to -0.26, P = 0.006); but PT (MD = -0.44, 95%CI was -1.23 to 0.36, P = 0.28) and PLT (MD = -0.08, 95%CI was -18.81 to 18.65, P = 0.99) between the two groups had no statistically significant differences. A funnel chart analysis of PaO2/FiO2 with 11 included papers showed that there might be publication bias. CONCLUSIONS: Low molecular weight heparin can improve the poor oxygenation of ARDS patients, reduce the mortality of ARDS patients in the acute stage and the inflammatory reaction, but it may increase the bleeding risk of ARDS patients.