PiCCO指导脓毒症治疗有效性的Meta分析

Meta-analysis of the effectiveness of PiCCO-guided sepsis treatment

目的采用Meta分析系统评价脉搏指示连续心输出量测定(PiCCO)指导脓毒症治疗的临床疗效。方法计算机检索万方、中国知网、维普、PubMed、Cochrane Library等数据库,查找建库以来应用PiCCO法监测指导脓毒症患者治疗的随机对照试验,采用Review manager 5.3和Stata16.0软件进行Meta分析。对照组为常规监测治疗组,PiCCO组使用PiCCO监测指导治疗,比较两组治疗后28d病死率、重症监护室(ICU)住院时长、机械通气时间,不同时段的中心静脉压(CVP)、平均动脉压(MAP)和血乳酸等指标。结果最终纳入18篇文献,共1575例患者。Meta分析结果显示:与对照组相比,PiCCO组28d病死率下降(OR,0.34;95%CI:0.21~0.58;P<0.0001);ICU住院时长减少(SMD:-1.70;95%CI:-2.36~-1.04;P<0.00001)及机械通气时间缩短(SMD:-0.91;95%CI:-1.41~-0.04;P=0.0004);血乳酸水平较低、MAP较高;6h时,CVP较低。结论对于脓毒症患者,PiCCO指导下的治疗效果优于常规监测。

Objective To evaluate the clinical efficacy of pulse-indicated continuous cardiac output measurement(PiCCO)to guide the treatment of sepsis using Meta-analysis system.Methods Computer search of databases such as Wanfang,China Knowledge Network,Vip,PubMed,and Cochrane Library was conducted to find randomized controlled trials that applied the PiCCO method to monitor and guide the treatment of sepsis patients since the establishment of the database,and Metaanalysis was performed using Review manager 5.3 and Stata 16.0 software.The control group was the conventional monitoring treatment group,and the PiCCO group used PiCCO monitoring to guide treatment,comparing the 28-day mortality rate,length of intensive care unit(ICU)stay,duration of mechanical ventilation,central venous pressure(CVP),mean arterial pressure(MAP)and blood lactate level at different time periods between the two groups.Results 18 articles were finally included,with a total of 1575 patients.Meta-analysis results showed that compared with the control group,the PiCCO group had a decreased 28-day morbidity rate(OR,0.34;95%CI,0.21~0.58;P<0.0001),reduced length of ICU stay(SMD:-1.70;95%CI:-2.36~1.04;P<0.00001),shorter duration of mechanical ventilation(SMD:-0.91;95%CI:-1.41~-0.04;P=0.0004),lower blood lactate levels and higher MAP and lower CVP at 6h.Conclusions In patients with sepsis,PiCCO-guided treatment was superior to conventional monitoring.