摘要
目的探讨乌司他丁治疗急性百草枯中毒的安全性和有效性,为临床治疗百草枯中毒提供决策依据。方法计算机检索Pub Med、Embase、The Cochrane library、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、万方数据库和维普数据库收录的有关乌司他丁治疗百草枯中毒的相关文献,依据Cochrane系统评价手册5.1.0版推荐的质量评价标准对临床随机对照试验(RCT)研究及Newcastle Ottawa Scale量表中质量评价标准对病例对照研究(CCS)进行评价,使用Rev Man5.2统计学软件进行数据分析并绘制森林图。结果本研究共纳入7篇CCS文献共计400例患者,无RCT文献,其中乌司他丁组202例,对照组198例。乌司他丁组与对照组比较,病死率差异有统计学意义[比值比(OR)=0.48,95%可信区间(CI)(0.32,0.71),P=0.0003];多脏器功能衰竭综合征(MODS)发生率差异无统计学意义[OR=0.56,95%CI(0.31,1.03),P=0.06];肺纤维化发生率差异有统计学意义[OR=0.44,95%CI(0.21,0.90),P=0.02];死亡病例存活时间差异无统计学意义[标准均数差(SMD)=0.49,95%CI(-0.08,1.05),P=0.09]。结论乌司他丁可降低百草枯中毒患者的病死率和肺纤维化发生率,但不能降低MODS发生率和延长死亡病例存活时间,相关数据证据等级较低,迫切需要多中心的RCT研究提供更有力的循证医学证据。
Objective To analyze the safety and efficiency of ulinastatin for acute paraquat poisoning,in order to provide decision evidence for clinical treatment of paraquat poisoning. Methods Pub Med,Embase,the Cochrane library,CBM,CNKI,WANFANG and VIP for the literature concerning ulinastatin for paraquat poisoning were searched. The randomized controlled trial（ RCT） by the Cochrane handbook 5. 1. 0 and the case control study（ CCS） by the Newcastle Ottawa Scale used to evaluate and synthesize data and to draw the forest graph by the Review Manager 5. 2 statistics software were analyzed.Results Seven articles,including 7 CCSs and 0 RCT involving 400 patients were collected in this research. There were 202 patients in ulinastatin group and 198 patients in control group,and the results of meta-analysis between ulinastatin group and control group are as follows： 1There was significant difference in mortality rate [OR = 0. 48,95% CI（ 0. 32,0. 71）,P =0. 0003]. 2There was no significant difference in incidence rate of MODS [OR = 0. 56,95% CI（ 0. 31,1. 03）,P = 0. 06].3There was significant difference in incidence rate of pulmonary fibrosis [OR = 0. 44,95% CI（ 0. 21,0. 90）,P = 0. 02].4There was no significant difference in the survival time of mrotatity cases [SMD = 0. 49,95% CI（-0. 08,1. 05）,P =0. 09]. Conclusion According to the current data,ulinastatin can reduce the mortality and incidence rates of pulmonary fibrosis,but cannot reduce incidence rate of MODS and prolong survival time of mortality cases. As the studies included are CCSs which are at a low level of evidence,it is urgently needed that multi-centered RCT research should provide more stronger evidence-based medical evidence.
出处
《临床误诊误治》
2016年第6期68-72,共5页
Clinical Misdiagnosis & Mistherapy
