呋塞米联用小剂量多巴胺治疗利尿剂抵抗性心力衰竭中国患者的Meta-分析

Meta-analysis of furosemide combined with low dose dopamine in treatment of diuretic resistant heart failure in China

目的系统评价呋塞米联用小剂量多巴胺治疗中国利尿剂抵抗性心力衰竭的有效性和安全性。方法检索PubMed、Embase、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)和万方数据库,收集呋塞米联用小剂量多巴胺(观察组)对比单用呋塞米(对照组)对利尿剂抵抗性心力衰竭的随机对照研究(RCT),检索时间从建库至2019年7月,提取资料并评价质量后,采用RevMan 5.3软件进行Meta-分析。结果共纳入12篇RCTs,927例中国患者。Meta-分析结果显示观察组临床有效率(RR=1.44,95%CI=1.32~1.56)、左心室射血分数增加值(MD=8.05,95%CI=7.52~8.75)、24 h尿量体积(SMD=2.77,95%CI=1.93~3.62)、6 min步行距离(MD=38.97,95%CI=24.10~53.85)均大于对照组,差异有统计学意义(P<0.01);血清肌酐水平(MD=-2.86,95%CI=-6.46~0.73)和药物不良反应发生率(MD=1.64,95%CI=0.59~4.57)与对照组比较无显著差异。结论对于心力衰竭合并利尿剂抵抗的中国患者而言,小剂量多巴胺联用呋塞米改善患者心功能、尿潴留、活动耐受力和抑制肾功能不全等均优于单用呋塞米,且安全性较好。

Objective To evaluate the efficacy and safety of furosemide combined with low dose dopamine in the treatment of diuretic resistant heart failure in China.Methods The randomized controlled trials(RCT)of furosemide combined with low dose dopamine(test group)vs furosemide alone(control group)of in the treatment of diuretic resistant heart failure in Chinese were searched from the database including Pubmed,Embase,CNKI,VIP,CBM and Wangfang by computer from the database to July2019.References of included studies were also retrieved.Screened studies according to inclusion and exclusion criteria,extracted valid data,and assessed the methodological quality of including literatures.Meta-analysis was performed using RevMan 5.3 software.Results A total of 12 RCTs and 927 patients were included.Meta-analysis showed that the clinical effective rate(RR=1.44,95%CI=1.32~1.56),left ventricular ejection fraction increased(MD=8.05,95%CI=7.52~8.75),24 h urine volume(SMD=2.77,95%CI=1.93~3.62],6 min WDT(MD=38.97,95%CI=24.10~53.85)in the test group were significantly higher than those in the control group(P<0.01);and there was no significant difference in serum creatinine level[MD=-2.86,95%CI=-6.46~0.73]and adverse drug reactions[MD=1.64,95%CI=0.59~4.57]between the two groups.Conclusion For Chinese patients with diuretic resistant heart failure,furosemide combined with low dose dopamine can improves cardiac function,urinary retention,activity tolerance and renal dysfunction,and safety is good.