血必净注射液治疗脓毒症心功能障碍有效性和安全性的Meta分析

Meta-analysis on the Efficacy and Safety of Xuebijing Injection in the Treatment of Sepsis-induced Myocardial Dysfunction

目的系统评价血必净注射液治疗脓毒症心功能障碍(SIMD)的有效性及安全性。方法检索中国知网数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、中国学术期刊数据库(万方)、Cochrane图书馆、Web of Science和PubMed中有关血必净注射液治疗SIMD的临床随机对照试验文献,提取纳入研究的相关数据并进行方法学质量评价。应用RevMan5.4.1软件进行Meta分析。结果共纳入10项研究、708例患者。Meta分析结果显示,在降低患者的心肌肌钙蛋白(cTnI)方面,血必净注射液联合常规治疗在治疗5 d后[MD=-0.30,95%CI(-0.57,-0.03)]和治疗7 d后[SMD=-1.78,95%CI(-2.83,-0.74)]均优于常规治疗(P<0.05);在降低患者心肌肌酸激酶同工酶(CK-MB)方面,血必净注射液联合常规治疗在治疗5 d后[SMD=-0.85,95%CI(-1.25,-0.45)]及治疗7 d后[SMD=-0.89,95%CI(-1.39,-0.39)]均优于常规治疗(P<0.05);在降低B型钠尿肽(BNP)方面,血必净注射液联合常规治疗在治疗7 d后[SMD=-1.70,95%CI(-2.92,-0.49)]优于常规治疗(P<0.05);在降低降钙素原(PCT)方面,血必净注射液联合常规治疗在治疗7 d后[SMD=-0.53,95%CI(-0.75,-0.32)]优于常规治疗(P<0.05);在缩短住院时间上,血必净注射液联合常规治疗[MD=-1.81,95%CI(-2.39,-1.23)]优于常规治疗(P<0.05);在病死率上,血必净注射液联合常规治疗与单纯常规治疗比较,差异无统计学意义(P>0.05)。在安全性方面,纳入研究报道血必净注射液有一定的不良反应,但未见严重不良反应,且与常规治疗差异无统计学意义(P>0.05),提示其安全性较好。结论血必净注射液辅助治疗SIMD能有效改善患者心功能障碍,且安全性较好。由于目前纳入文献数量不多且文献质量不高,期望今后有更多高质量的随机对照试验支持。

Objective:To systematically evaluate the efficacy and safety of Xuebijing Injection in the treatment of sepsis-induced myocardial dysfunction(SIMD).Methods:The China National Knowledge Infrastructure(CNKI),VIP Chinese Science and Technology Periodicals Full-text Database(VIP),Wanfang China Academic Journals Database(Wanfang),Cochrane Library,Web of Science and PubMed databases were searched for Xuebijing Injection in the treatment of SIMD.For clinical randomized controlled trials,relevant data of included studies were extracted and the methodological quality was evaluated.Meta-analysis was performed using RevMan 5.4.1software.Results:A total of 10 studies and 708 patients were included.The results of meta-analysis showed that Xuebijing Injection combined with conventional treatment in reducing the cardiac troponin(cTnI)of patients after 5 days of treatment[MD=-0.30,95%CI(-0.57,-0.03)]and after 7 days of treatment[SMD=-1.78,95%CI(-2.83,-0.74)]were better than conventional treatmen(tP<0.05);Xuebijing Injection was used to reduce myocardial creatine kinase isoenzyme(CK-MB)in patients after 5 days of treatment[SMD=-0.85,95%C(I-1.25,-0.45)]and after 7 days of treatment[SMD=-0.89,95%CI(-1.39,-0.39)],and the combination treatment was better than conventional treatmen(tP<0.05);Xuebijing Injection combined with conventional treatment was better than conventional treatment 7 days after treatment[SMD=-1.70,95%C(I-2.92,-0.49)]in reducing B-type natriuretic peptide(BNP)(P<0.05);in terms of reducing procalcitonin(PCT),Xuebijing Injection combined with conventional treatment after 7 days of treatment[SMD=-0.53,95%CI(-0.75,-0.32)]was better than conventional treatment(P<0.05);Xuebijing Injection combined with conventional treatment[MD=-1.81,95%CI(-2.39,-1.23)]was better than conventional treatment in shortening hospital stay(P<0.05);in terms of mortality,Xuebijing Injection combined with conventional treatment and conventional treatment alone showed no statistically significant difference(P>0.05).In terms of safety,the included studies reported that Xuebijing Injection had certain adverse reactions,but no serious adverse reactions were found,and there was no statistical significance compared with conventional treatment,suggesting that its safety is good.Conclusion:Xuebijing Injection adjuvant treatment of SIMD can effectively improve the patients′cardiac dysfunction with good safety.Due to the limited number of included literature and the low quality of literature,this conclusion needs to be treated with caution,and more high-quality randomized controlled trials are needed to support this conclusion in the future.