多巴胺与去甲肾上腺素治疗感染性休克疗效比较的系统评价

Dopamine versus Norepinephrine for Septic Shock:A Systemic Review

目的系统评价多巴胺与去甲肾上腺素治疗感染性休克的疗效及安全性。方法计算机检索MEDLINE、EMbase、Cochrane图书馆、VIP、CNKI、CBM和WanFang Data等数据库(检索时限均从建库至2011年6月),纳入所有使用多巴胺或去甲肾上腺素治疗感染性休克的随机对照试验(RCT)。评价纳入研究的方法学质量和提取有效数据后,采用RevMan 5.1软件进行Meta分析。结果共纳入9个RCT,3 179例休克患者。Meta分析结果显示:多巴胺同去甲肾上腺素相比,能使感染性休克患者住院期间死亡风险增加12%,其差异具有统计学意义[RR=1.12,95%CI(1.04,1.21),P=0.002];多巴胺组感染性休克患者心率失常事件发生风险是去甲肾上腺素组的2.63倍[RR=2.63,95%C(I1.51,4.55),P=0.000 6];多巴胺组心脏指数较去甲肾上腺素组增加[MD=0.42,95%C(I0.21,0.63),P<0.000 1];但在心率[MD=17.05,95%CI(–0.71,34.81),P=0.06]及平均动脉压[MD=–0.87,95%CI(–24.97,7.62),P=0.30]方面,两组差异无统计学意义。结论去甲肾上腺素同多巴胺相比能显著降低感染性休克患者住院期间死亡率,降低心律失常事件的发生率,其疗效及安全性优于多巴胺。

Objective To systemically review the efficacy and safety of dopamine versus norepinephrine in pa- tients with septic shock. Methods Database searches of MEDLINE, EMbase, Cochrane Controlled Trials Register, VIP, CNKI, and CBM （from the date of database establishment to June 2011） were conducted. Additional studies for collect- ing relevant data were retrieved via both references of articles and direct contact with authors. Prospectively, randomized controlled trials （RCTs） of dopamine compared with norepinephrine therapy in septic shock patients were selected. The quality of included trials was assessed and relevant data were extracted. Then statistical analysis was performed using Rev- Man 5.1. Results Nine trials with 3 179 participants were included. The results ofmeta-analysis showed： compared with norepinephrine, dopamine was associated with a significant 12% elevation in the risk ratio of in-hospital death events of septic shock patients （RR=I.12, 95%CI 1.04 to 1.21, P=0.002）. The risk of arrhythmias in dopamine group was 2.63- fold than that in norepinephrine group （RR=2.63, 95%CI 1.51 to 4.55, P=0.000 6）. The cardiac index of septic patients in dopamine group was higher than that in norepinephrine group （MD=0.42, 95%CI 0.21 to 0.63, P〈0.000 1）. No significant difference could be found in the heart rate （MD=17.05, 95%CI -0.71 to 34.81, P=0.06） and mean arterial pressure （MD= -0.87, 95%CI -24.97 to 7.62, P=0.30）. Conclusion Findings from this meta-analysis suggest that compared with dopa- mine, norepinephrine significantly reduces both 28-day mortality of septic shock patients and incidence rate of arrhyth- mias. Norepinephrine is better than dopamine in aspects of efficacy and safety.