左西孟旦用于严重脓毒血症和脓毒性休克并发心力衰竭患者的Meta分析

Meta-analysis of use of levosimendan in severe sepsis and septic shock patients complicated with heart failure

目的评价与标准强心剂(多巴酚丁胺类药物)对比,左西孟旦能否取得令临床满意的治疗效果。方法检索2005年1月-2015年12月CNKI、CBM、VIP、万方数据、BioMedCentral、Embase、Pubmed、Central中符合条件的文献;左西孟旦应用于严重脓毒血症和脓毒性休克并发心衰患者且有病死率描述的随机对照试验将被纳入;本研究首要结果是病死率,次要指标为心排血指数(CI)、血清乳酸浓度(LAC)、左心室射血分数(LVEF)、左心室每搏作功指数(LVSWI)、平均动脉压(MAP)。结果共411例患者的11项研究被纳入到本次分析;左西孟旦组病死率为36.8%(77/209),对照组病死率为47.5%(96/202),RR=0.77[0.62,0.95],P=0.02,同质性检验P=0.98,I2=0%;与对照组相比,CI、LVEF、LVSWI升高,LAC降低,MAP差异无统计学意义。结论在严重脓毒血症和脓毒性休克患者中,左西孟旦与标准强心剂治疗相比,可降低病死率。本结论需进行大型多中心随机对照试验验证。

OBJECTIVE To determine whether levosimendan,as compared with standard inotropic therapy（dobutamine）,can achieve promising results in clinical treatment.METHODS From Jan 2005 to Dec 2015,the databases such as CNKI,CBM,VIP,Wanfang data,BioMedCentral,Embase,Pubmed and Central were searched for eligible literatures,the randomized controlled trials for the use of levosimendan in the severe sepsis and septic shock patients complicated with heart failure and description of mortality rates were included;the primary outcome was mortality rate,whereas the secondary outcomes were cardiac index（CI）,serum lactate concentration（LAC）,left ventricular ejection fraction（LVEF）,left ventricular stroke work index（LVSWI）and mean arterial pressure（MAP）.RESULTS Totally 11 trials involving 411 patients were included in the study.The mortality rate was36.8%（77/209）in the levosimendan group,47.5%（96/202）in the control group RR=0.77[0.62,0.95],P =0.02,homogeneity test P=0.98,I2=0%.The CI,LVEF and LVSWI of the levosimendan group were higher than those of the control group,the LAC level of the levosimendan group was lower than that of the control group,and there was no significant difference in the MAP between the two groups.CONCLUSION As compared with the standard inotropic therapy,levosimendan may reduce the mortality rate of the severe sepsis and septic shock patients,which needs to be verified by large-scale multicenter randomized controlled trials.