艾司洛尔治疗脓毒性休克有效性及安全性的Meta分析

目的系统评价艾司洛尔治疗脓毒性休克的有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、EMbase、万方数据知识服务平台、中国知网(CNKI)和维普网(VIP)数据库,检索艾司洛尔治疗脓毒性休克的相关研究,各个数据库的检索时间均为建库至2020年4月。由2名研究员独立进行文献检索并筛选文献、收集数据并评价纳入研究的偏倚风险后,采用STATA12.0软件进行Meta分析。结果共纳入12项随机对照试验,共计1 018例脓毒性休克患者,其中试验组510例,对照组508例。Meta分析结果显示:与对照组相比,试验组28d病死率更低(RR=0.76,95%CI:0.63~0.92,P<0.001),心率(WMD=-19.67,95%CI:-25.10~-14.23,P<0.001)和乳酸值(WMD=-0.87,95%CI:-1.45~-0.30,P=0.003)降低更明显,平均动脉压(MAP)升高幅度更大(WMD=0.64,95%CI:0.10~1.18,P=0.021),差异均有统计学意义;中心静脉压(CVP)差异无统计学意义(WMD=-0.42,95%CI:-1.14~0.30,P=0.254)。结论当前证据表明,艾司洛尔能够降低脓毒性休克患者的28d病死率,降低心率,同时对血流动力学无明显影响。

Effectiveness and safety of esmolol in treatment of patients with septic shock:a Meta analysis

Objective To systematically review the effectiveness and safety of esmolol in treating septic shock.Methods The PubMed,Cochrane Library,EMbase,CNKI,VIP and WanFang data knowledge service platform were retrieved by computer to collect the related studies on esmolol in treating septic shock.The retrieval time in each database was from its establishement to April 2020.2 researchers independently conducted the literature retrieval,collected the data and assessed the risk of bias for the included studies.Then the Meta analysis was performed by using the STATA12.0 software.Results A total of 12 randomized controlled trials(RCTs)involving 1018 patients with septic shock were included,510 cases in the experiment group and 508 cases in the control group.The Meta analysis results showed that compared with the control group,the 28 d mortality rate in the experiment group was lower(RR=0.76,95%CI:0.63-0.92,P<0.001),the heart rate value decrease was more significant(WMD=-19.67,95%CI:-25.10--14.23,P<0.001),lactic acid value decrease was more significant(WMD=-0.87,95%CI:-1.45--0.30,P=0.003),the ascending range of mean arterial pressure was greater(WMD=0.64,95%CI:0.10-1.18,P=0.021),and the differences were statistically significant;but the change of central venous pressure had no significant difference(WMD=-0.42,95%CI:-1.14-0.30,P=0.254).Conclusion The current evidence shows that esmolol can decrease the 28 d mortality rate and heart rate in the patients with septic shock,meanwhile has no significant effect on hemodynamics.