摘要
目的系统评价氢化可的松联合维生素C、维生素B1对脓毒症或脓毒性休克患者疗效的影响。方法计算机检索中国知网、中国生物医学文献服务系统(Sino Med)、维普数据库、万方数据库、美国国立医学图书馆数据库(PubMed)、Cochrane图书馆、荷兰医学文摘(Embase),收集关于氢化可的松联合维生素C、维生素B1治疗脓毒症或脓毒性休克的随机对照试验(RCT),检索时限均为建库至2021年1月。试验组在常规治疗基础上静脉注射氢化可的松、维生素B1和维生素C;对照组给予常规治疗或在常规治疗基础上给予安慰剂/氢化可的松/氢化可的松+维生素B1。结局指标包括:序贯器官衰竭评分(SOFA)、病死率、血管活性药物使用时间、新发急性肾损伤(AKI)、重症监护病房(ICU)住院时间和总住院时间。由2名研究员独立筛选文献、提取资料和评价纳入文献的偏倚风险。采用RevMan 5.3软件进行Meta分析;采用漏斗图分析发表偏倚。结果共纳入6篇文献,816例患者。试验组411例,对照组405例。Meta分析结果显示:试验组血管活性药物使用时间较对照组明显缩短〔均数差(MD)=-24.02,95%可信区间(95%CI)为-32.36~-15.68,P<0.00001〕,但两组SOFA评分、病死率、新发AKI、ICU住院时间、总住院时间比较差异均无统计学意义〔SOFA评分:MD=-0.14,95%CI为-1.15~0.87,P=0.79;病死率:相对危险度(RR)=0.99,95%CI为0.81~1.21,P=0.92;新发AKI:RR=1.10,95%CI为0.42~2.87,P=0.84;ICU住院时间:MD=1.33,95%CI为-2.22~4.89,P=0.46;总住院时间:MD=1.02,95%CI为-0.66~2.69,P=0.23〕。漏斗图结果显示,大部分点基本对称,呈倒漏斗状,提示各研究间发表偏倚较小,说明发表偏倚对此次Meta分析结果影响较小。结论氢化可的松联合维生素C、维生素B1能缩短脓毒症或脓毒性休克患者血管活性药物使用时间,但不能有效降低患者的SOFA评分、病死率、新发AKI、ICU住院时间和总住院时间;受纳入研究数�
Objective To systematically evaluate the effect of hydrocortisone combined with vitamin C and vitamin B1 on the efficacy of patients with sepsis or septic shock.Methods Databases including CNKI,Sino Med,VIP,Wanfang,PubMed,the Cochrane Library,and Embase were searched from inception to January 2021 for the randomized controlled trial(RCT)about hydrocortisone combined with vitamin C and vitamin B1 to treat sepsis or septic shock.The experimental group was given intravenous injection of hydrocortisone,vitamin B1 and vitamin C based on conventional treatment;the control group was given conventional treatment or placebo/hydrocortisone/hydrocortisone+vitamin B1 based on conventional treatment.Outcome indicators included sequential organ failure assessment(SOFA),mortality,the duration of vasoactive drugs,new acute kidney injury(AKI)patients,length of stay in intensive care unit(ICU)and in hospital.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies.RevMan 5.3 software was then used to perform Meta-analysis.Funnel plot was used to test publication bias.Results A total of 6 articles involving 816 patients were included,with 411 patients in the experimental group and 405 patients in the control group.The Meta-analysis results showed that the duration of vasoactive drugs in the experimental group was significantly shorter than that in the control group[mean difference(MD)=-24.02,95%confidence interval(95%CI)was-32.36 to-15.68,P<0.00001].However,there were no significant differences in SOFA,mortality,new AKI patients,the length of ICU stay and hospital stay between the two groups[SOFA:MD=-0.14,95%CI was-1.15 to 0.87,P=0.79;mortality:relative risk(RR)=0.99,95%CI was 0.81 to 1.21,P=0.92;new AKI patients:RR=1.10,95%CI was 0.42 to 2.87,P=0.84;length of ICU stay:MD=1.33,95%CI was-2.22 to 4.89,P=0.46;length of hospital stay:MD=1.02,95%CI was-0.66 to 2.69,P=0.23].The funnel plot showed that most of the points were symmetrical and showed an inverted funnel shape
作者
常晨阳
罗开源
朱惠芳
邓国平
高倩男
Chang Chenyang;Luo Kaiyuan;Zhu Huifang;Deng Guoping;Gao Qiannan(Gannan Medical College,Ganzhou 341000,Jiangxi,China;Children's Medical Center,First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,Jiangxi,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第9期1040-1046,共7页
Chinese Critical Care Medicine
基金
江西省医药卫生科技计划项目(20204503)
。
