系统评价氢化可的松持续静脉泵注给药与静脉滴注给药对脓毒症休克患者近期预后的影响

Systematic Review on Effects of Continuous Intravenous Pump Administration and Intravenous Drip Administration of Hydrocortisone on Short-Term Prognosis in Patients with Septic Shock

目的:系统评价氢化可的松静脉泵注给药与静脉滴注给药对脓毒症休克患者近期预后的影响。方法:检索中国知网、万方数据库、维普数据库、中国生物医学数据库、PubMed、Embase、MEDLINE、Web of Science和the Cochrane Library等数据库自建库至2022年4月关于氢化可的松持续静脉泵注与静脉滴注治疗脓毒症休克的随机对照试验,进行文献筛选和提取有效数据后,采用RevMan 5.3软件进行Meta分析。结果:纳入15篇文献,共1628例患者,其中809例采用静脉滴注给药,819例采用持续静脉泵注给药。Meta分析结果显示,氢化可的松持续静脉泵注给药的28 d病死率(26.65%,182/683)低于静脉滴注给药(30.65%,206/672),但差异无统计学意义(RR=0.86,95%CI=0.73~1.02,P=0.08);与静脉滴注给药比较,持续静脉泵注给药能显著提高患者的血清乳酸清除率(MD=1.39,95%CI=0.90~1.87,P<0.00001),缩短休克持续时间(MD=-0.18,95%CI=-0.26~-0.11,P<0.00001)、入住重症监护室(ICU)时间(MD=-1.54,95%CI=-1.82~-1.26,P<0.00001)和总住院时间(MD=-0.94,95%CI=-1.31~-0.57,P<0.00001),差异均有统计学意义。结论:与氢化可的松多次静脉滴注给药方式相比,持续静脉泵注给药尽管不能显著降低脓毒症休克患者的28 d病死率,但可显著降低患者血乳酸水平,尽快扭转休克持续时间,缩短入住ICU时间和总住院时间。

OBJECTIVE:To systematically evaluate the effects of continuous intravenous pump administration and intravenous drip administration of hydrocortisone on short-term prognosis in patients with septic shock.METHODS:CNKI,Wanfang Data,VIP,CBM,PubMed,Embase,MEDLINE,Web of Science and the Cochrane Library databases were retrieved to collect randomized controlled trials of continuous intravenous pump administration and intravenous drip administration of hydrocortisone in the treatment of patients with septic shock.The retrieval time was from the establishment of the database to Apr.2022.After literature screening and effective data extraction,RevMan 5.3 software was used for Meta-analysis.RESULTS:Totally 15 articles were enrolled,including 1628 patients,809 cases of whom received intravenous infusion and 819 cases of whom received continuous intravenous pump administration.Results of Meta-analysis showed that the 28-day mortality rate of continuous intravenous pump administration of hydrocortisone(26.65%,182/683)was lower than that of intravenous drip administration(30.65%,206/672),yet the difference was not statistically significant(RR=0.86,95%CI=0.73-1.02,P=0.08).Compared with intravenous drip administration,continuous intravenous pump administration could significantly improve the serum lactate clearance(MD=1.39,95%CI=0.90-1.87,P<0.00001),shorten the duration of shock(MD=-0.18,95%CI=-0.26--0.11,P<0.00001),length of stay in intensive care unit(ICU)(MD=-1.54,95%CI=-1.82--1.26,P<0.00001),and total length of stay(MD=-0.94,95%CI=-1.31--0.57,P<0.00001),the differences were statistically significant.CONCLUSIONS:Compared with multiple intravenous drip administration of hydrocortisone,continuous intravenous pump administration can not significantly reduce the 28-day mortality of patients with septic shock,yet can significantly reduce the level of blood lactic acid,reverse the duration of shock as soon as possible,shorten the length of stay in ICU and total length of stay.