摘要
目的系统评价参附注射液对脓毒症的临床疗效,为临床提供循证参考。方法计算机检索Pubmed、万方电子资源网、中国知网(CNKI)、维普(VIP),收集采用参附注射液治疗脓毒症为干预措施的临床随机对照试验。提取资料和对最终纳入的文献进行改良的Jadad方法学质量评价后,采用Revman 5.3软件对数据进行Meta分析。结果共纳入17篇随机对照研究,包括英文文献1篇,中文文献16篇,共1 155例脓毒症患者,其中参附组589例患者,对照组566例患者。Meta分析结果显示:参附组28 d病死率低于对照组患者,差异具有统计学意义[RR=0.71,95%CI(0.61,0.83),P <0.0001];参附组ICU住院时间短于对照组[MD=-1.06,95%CI(-1.08,-0.32),P=0.005];治疗后,参附组乳酸水平低于对照组[MD=-1.07,95%CI(-1.74,-0.40),P=0.002];对参附治疗后不同时间点的急性生理学与慢性健康评价Ⅱ(APACHEⅡ评分)进行亚组分析,发现参附组在不同时间点均比对照组有更低的APACHEⅡ评分,24 h:[MD=-2.64,95%CI (-4.77,-0.51),P=0.02]。48 h:[MD=-3.42,95%CI(-4.68,-2.16),P <0.00001]。7 d:[MD=-1.27,95%CI(-2.36,-0.18),P=0.02]。14 d:[MD=-4.89,95%CI(-5.85,-3.93),P <0.00001]。结论根据目前已有的研究,采用参附注射液治疗脓毒症能够降低患者28 d病死率、缩短ICU住院时间、降低血乳酸水平、降低APACHEⅡ评分,改善脓毒症患者预后,但是由于大多数研究质量偏低,需更多高质量的临床随机对照研究进一步证实参附注射液治疗脓毒症的疗效。
Objective:To systematically evaluate the clinical effects of Shenfu Injection on septic patients,providing evidence-based reference for clinic.Methods:Pubmed,Wanfang Electronic Resources Network,CNKI and VIP were searched.Randomized controlled clinical trials using Shenfu Injection for sepsis were collected.After extracting data and the modified Jadad methodological evaluation,the data were meta-analyzed by Revman 5.3 software.Results:17 RCTs were included,1 in English and 16 in Chinese,involving 1 155 septic patients,589 in Shenfu group and 566 in the control group.As the Meta-analysis showed,the 28-day mortality of Shenfu group was lower than that of the control group;the difference was statistically significant(RR=0.71,95%CI=0.61,0.83,P<0.0001).The hospitalization time of ICU in Shenfu group was shorter than that in control group;the difference was statistically significant[MD=-1.06,95%CI(-1.08,-0.32),P=0.005].After treatment,the level of lactate in Shenfu group was lower than that in the control group[MD=-1.07,95%CI(-1.74,-0.40),P=0.002].Subgroup analysis of APACHEⅡscores at different time points revealed that Shenfu group had lower APACHEⅡscore at different time points than the control group.24 hours:[MD=-2.64,95%CI(-4.77,-0.51),P=0.02];48 hours:[MD=-3.42,95%CI(-4.68,-2.16),P<0.00001];7 days:[MD=-1.27,95%CI(-2.36,-0.18),P=0.02];14 days:[MD=-4.89,95%CI(-5.85,-3.93),P<0.00001].Conclusion:According to present studies,Shenfu Injection can reduce the 28-day mortality rate,shorten ICU hospitalization time,reduce blood lactate level,reduce APACHEⅡscore and improve the prognosis of sepsis patients.However,due to the low quality of most studies,more high-quality clinical randomized controlled studies are needed to further confirm the efficacy of Shenfu Injection on sepsis.
作者
于辉
汪月奔
甄军海
操蓓蓓
张菊明
Yu Hui;Wang Yueben;Zhen Junhai(The First people′s Hospital in Aksu Prefecture,Xinjiang Uygur Autonomous Region,Xinjiang,Aksu 843000,China)
出处
《中国中医急症》
2019年第1期29-33,共5页
Journal of Emergency in Traditional Chinese Medicine
基金
浙江省中医药科技计划项目(2019ZB004)
