早期目标乳酸清除率治疗严重脓毒症或脓毒性休克的Meta分析

Early Goal Lactate Clearance Rate Therapy in Patients with Severe Sepsis or Septic Shock:A Meta Analysis

目的评价早期目标乳酸清除率对严重脓毒症或脓毒性休克患者的治疗作用。方法检索2016年3月5日之前Pub Med、EMBASE、Cochrane Library、CNKI和万方的文献。纳入标准:研究类型为随机对照试验(RCT);研究对象为严重脓毒症或脓毒性休克患者;结局指标为28天病死率、ICU住院时间以及总住院时间。采用Revman5.3软件对所提取文献资料进行Meta分析。结果最终纳入5篇RCT,包含860例患者。Meta分析结果表明早期目标乳酸清除率治疗可以降低严重脓毒症或脓毒性休克患者的28天病死率(RR=0.73,95%CI:0.60~0.88,P<0.01),缩短ICU住院时间(WMD=-2.41,95%CI:-4.68^-0.14,P<0.05),但是对总住院时间无影响(WMD=-0.13,95%CI:-4.58~4.31,P=0.95)。结论早期目标乳酸清除率治疗可以降低严重脓毒症或脓毒性休克患者的28天病死率,缩短ICU住院时间,但是不影响总住院时间。

Objective To investigate the effect of early goal lactate clearance rate therapy in patients with severe sepsis or septic shock. Methods Articles were retrieved from PuhMed, Embase, Cochrane Library,Wanfang and CNKI before March 5, 2016. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial （RCT） ,which endpoints were the mortality,the length of ICU stay and hospital stay. RevMan 5.3 software was used for Meta analysis. Results There were 5 RCTs meeting inclusive criteria including 860 patients. It was shown by Meta analysis that early goal lactate clearance rate therapy was associated with decrease in the 28 - day mortality （ RR = 0.73, 95% CI： 0.60 - 0.88, P 〈 0.01 ） , shorten the length of ICU stay （ W MD = - 2.41, 95 % C I： - 4.68 - - 0.14, P 〈 0.05 ）, but not associated with decrease of the length of hospital stay （ W MD = - 0.13, 95 % CI ： - 4.58 - 4.31, P = 0.95 ）. Conclusion Early goal lactate clearance rate therapy was associated with significant improvement in 28 - day mortality and the length of ICU stay but not with the length of hospital stay in patients with severe sepsis or septic shock.