血必净注射液对脓毒症乳酸清除效果的Meta分析

Meta-analysis of the effect of Xuebijing injection on lactic acid clearance in sepsis

目的系统评价血必净注射液对脓毒症乳酸清除的效果,为血必净注射液在脓毒症乳酸清除领域的应用提供理论依据。方法检索中英文数据库包括中国知网(CNKI)、万方数据、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library数据库、科学网(Web of Science)中发表的有关血必净注射液对脓毒症乳酸清除效果的随机对照试验(RCT),采用Cochrane Handbook 5.1.0标准进行质量评价,运用RevMan 5.4软件对数据进行Meta分析。采用漏斗图分析纳入研究是否存在发表偏倚。结果共纳入文献13篇,872例患者,其中试验组(给予血必净注射液加常规治疗)446例,对照组(给予常规治疗)426例。Meta分析结果显示,试验组治疗后12 h和24 h血乳酸水平明显低于对照组〔均数差(MD)分别为-0.88、-0.73;95%可信区间(95%CI)分别为-1.26~-0.50、-0.89~-0.57,均P<0.0001〕;试验组在提高患者24 h乳酸清除率方面优于对照组(MD=17.20,95%CI为8.80~25.59,P<0.0001);与对照组比较,试验组更有利于降低患者序贯器官衰竭评分(SOFA,MD=-2.41,95%CI为-2.79~-2.03,P<0.00001)和28 d病死率〔优势比(OR)=0.51,95%CI为0.30~0.88,P=0.02〕。结论血必净注射液有利于提高脓毒症患者乳酸清除能力,能缓解脓毒症病情,改善患者预后。

Objective To systematically evaluate the effect of Xuebijing injection on lactic acid clearance in sepsis,and to provide the theoretical basis for the application of Xuebijing injection in the field of lactic acid clearance in sepsis.Methods Randomized controlled trials(RCT)of the effect of Xuebijing injection on lactic acid clearance in sepsis were retrieved in Chinese and English databases,including China National Knowledge Internet(CNKI),Wanfang Database,VIP Database,Chinese Biomedical Database(CBM),PubMed,Embase,Cochrane Library Database,and Web of Science.These trials were evaluated according to the Cochrane Handbook 5.1.0 standard and analyzed using RevMan 5.4 software for Meta-analysis.Funnel plots were used to assess publication bias in the included studies Results A total of 13 articles with 872 patients were included,including 446 patients in the experimental group(Xuebijing injection and conventional treatment group)and 426 patients in the control group(conventional treatment group).Meta-analysis showed that the blood lactic acid concentrations at 12 hours and 24 hours in the experimental group were lower than those of the control group[mean difference(MD)=-0.88,-0.73;95%confidence interval(95%CI)were-1.26 to-0.50,-0.89 to-0.57;P<0.0001].The experimental group exhibited a better 24 hours lactic acid clearance rate(MD=17.20,95%CI was 8.80 to 25.59;P<0.0001),and a reduced sequential organ failure assessment(SOFA)score(MD=-2.41,95%CI was-2.79 to-2.03,P<0.00001).Additionally,the experimental group demonstrated lower 28-day mortality rates compared to the control group[odds ratio(OR)=0.51,95%CI was 0.30-0.88,P=0.02];the differences were all statistically significant.Conclusion Xuebijing injection benefits by enhancing the lactic acid clearance capacity of sepsis patients,thereby alleviating the sepsis condition and improve improving the prognosis.