左西孟旦治疗严重脓毒症及脓毒症休克的临床疗效的Meta分析

Meta analysis of levosimendan in treatment of severe sepsis and septic shock

目的采用Meta分析评价左西孟旦在严重脓毒症及脓毒症休克中的疗效,为其在脓毒症中的治疗提供循证医学证据。方法使用中文和英文数据库,检索左西孟旦治疗严重脓毒症及脓毒症休克的随机对照研究。设定文献纳入和排除标准,对符合标准文献进行质量评定并进行数据提取。应用RevMan 5.3对相关研究的病死率、左心室射血分数(LVEF)、心脏指数(CI)、肌钙蛋白I(TnI)、乳酸(Lac)、去甲肾上腺素用量进行分析。结果共纳入13项研究,491例患者,其中左西孟旦组251例,对照组240例。与对照组相比,左西孟旦组的病死率显著降低(RR=0.78,95%CI=0.63~0.96,P=0.02),CI(WMD=0.79,95%CI=0.56~1.03,P<0.01)、LVEF(WMD=9.03%,95%CI=6.74%~11.31%,P<0.01)显著升高,TnI(WMD=-1.22,95%CI=-1.52^-0.77,P<0.01)、Lac(WMD=-1.41,95%CI=-1.56^-1.27,P<0.01)显著降低,两组去甲肾上腺素用量(WMD=-0.01,95%CI=-0.03~0.01,P=0.45)差异无统计学意义。结论与对照组相比,左西孟旦能显著降低严重脓毒症及脓毒症休克患者病死率,降低Lac及TnI的水平,增加CI及LVEF。Meta分析证据支持在严重脓毒症及脓毒症休克中应用左西孟旦。

Objective To analyze and evaluate the effect of levosimendan in the treatment of severe sepsis and septic shock through meta-analysis, and then to provide evident-based evidence for its application in the treatment of sepsis. Methods The CNKI, VIP, Wanfang database, PubMed, EMBASE, Ovidand Cochrane library database were searched for the randomized controlled trials of levosimendan in the treatment of severe sepsis and septic shock from the database inception to October 2015. Meta-analysis was conducted on the mortality, the left ventricular ejection fraction （LVEF）, the cardiac index （CI）, troponin I （TnI）, lactate （Lac） and the amount of norepinephrine by using RevMan5.3 software. Results A total of 13 articles involving 491 cases were included, of which 251 cases were in levosimendan group, while the other 240 cases were in the control group. Compared with the control group, the mortality of the patients in the levosimendan group decreased significantly （ RR = 0.78 ,95% CI = 0.63 - 0.96 , P = 0.02 ）. Cardiac index （WMD= 0.79 , 95% CI = 0.56 - 1.03 , P 〈 0.001 ）, LVEF （WMD= 9.03% ,95% CI = 6.74% - 11.31% , P 〈 0.00001 ） of the levosimendan group increased significantly. And the TnI （WMD= -1.22 ,95% CI = -1.52 - -0.77 , P 〈 0.00001 ）, lactate （WMD= -1.41 ,95% CI = -1.56 - -1.27 , P 〈 0.00001 ） decreased significantly compared with control group. There was no significant difference in the amount of norepinephrine between the two groups （WMD= -0.01 , 95% CI = -0.03 - 0.01 , P = 0.45 ）. Conclusion The evidence of meta- analysis supports the application of levosimendan in paitents with severe sepsis or septic shock.