摘要
目的评估静脉注射维生素C对脓毒症患者的疗效。方法计算机检索PubMed、Embase、Scopus、Cochrane Library和Clinical Trials数据库,检索时限为建库至2022年12月。收集静脉注射维生素C治疗脓毒症或脓毒性休克的随机对照试验(RCT)英文文献。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Stata 15.0软件进行Meta分析。结果共纳入16项RCT研究,包括3301例患者。主要结局方面,维生素C治疗组患者28天病死率略低于对照组,但差异无统计学意义[RR=0.86,95%CI(0.72~1.03),P=0.10;I 2=44%,P=0.10]。次要结局方面,静脉注射维生素C可缩短血管活性药物使用时间[MD=-23.44,95%CI(-30.53~-16.35),P<0.01;I 2=0,P=0.97],但对患者90天病死率、重症监护病房(ICU)病死率、医院病死率、机械通气持续时间、72 h序贯器官衰竭估计评分差值(△SOFA)、ICU住院时间、总住院时间无明显影响(P>0.05)。结论静脉注射维生素C可明显缩短血管活性药物使用时间,但现有证据尚不足以支持静脉注射维生素C可改善脓毒症或脓毒性休克患者的预后。需要更多高质量、多中心的RCT研究提供更多关于维生素C治疗脓毒症或脓毒性休克疗效的实质性证据。
Objective To evaluate the efficacy of vitamin C intravenous injection in the treatment of patients with sepsis.Methods PubMed,Embase,Scopus,Cochrane Library,and Clinical Trial databases were retrieved,with a retrieval period from database establishment to December 2022.English literatures on randomized controlled trial(RCT)of vitamin C intravenous injection for the treatment of sepsis or septic shock were collected.Meta-analysis was conducted using RevMan 5.3 software and Stata 15.0 software after literature screening,extraction,and evalua-tion of the bias risk included in the studies by two researchers independently.Results A total of 16 RCT studies involving 3301 patients were included in the analysis.In terms of main outcomes,the 28-day mortality of patients in the vitamin C treatment group was slightly lower than that of the control group,but the difference was not statistically significant(RR=0.86,95%CI[0.72-1.03],P=0.10;I 2=44%,P=0.10).In terms of secondary outcomes,vitamin C intravenous injection can reduce the duration of vasoactive drug usage time(MD=-23.44,95%CI[-30.53--16.35],P<0.01;I 2=0,P=0.97),but has no significant effect on the 90-day mortality,intensive care unit mortality,hospital mortality,duration of mechanical ventilation,difference in estimated sequential organ failure assessment score at 72 hour,length of stay in ICU,and total length of hospital stay of patients(P>0.05).Conclusion Intravenous vitamin C injection can significantly reduce vasoactive drug usage time,but the available evidence is insufficient to support that intravenous vitamin C can improve the prognosis of patients with sepsis or septic shock.More high-quality,multicenter randomized controlled trial is needed to provide more substantial evidence about the efficacy of vitamin C in treating sepsis or septic shock.
作者
赵国敏
边伟帅
甄洁
陈炜
ZHAO Guo-min;BIAN Wei-shuai;ZHEN Jie;CHEN Wei(Department of Critical Care Medicine,Emergency and Critical Care Medical Center,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2024年第1期32-41,共10页
Chinese Journal of Infection Control
基金
国家重点研发计划项目(2020YFC2005403)
2022年度北京市重大疫情防治重点专科建设类项目(ZDYQFZZDZK)
北京市属医院科研培育计划项目(PX2020031)。
