血必净联合乌司他丁治疗烧伤脓毒症临床疗效的系统评价

Clinical efficacy of Xuebijing combined with ulinastatin in treatment of burn sepsis:a systematic review

[目的]系统性评价和探讨血必净联合乌司他丁治疗烧伤脓毒症患者的临床疗效。[方法]计算机检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane library、EMbase和SpringerLink数据,各数据库检索年限均为从建库至2018年4月,查找并纳入有关血必净联合乌司他丁治疗烧伤脓毒症患者临床疗效的随机对照试验,Cochrane风险偏倚评价工具评价纳入文献质量后,使用RevMan 5.3软件进行Meta分析。[结果]共纳入临床随机对照试验文献9篇,其中治疗组共计308例患者在抗烧伤休克、液体复苏、抗感染、营养支持等常规治疗基础上给予血必净联合乌司他丁治疗,对照组301例患者仅给予与治疗组相同常规治疗方案。Meta分析结果显示,与对照组相比,治疗组患者降钙素原(PCT)水平比较,差异无统计学意义[SMD=-1.70,95%CI(-3.65,-0.26),P=0.09];治疗组患者C反应蛋白(CRP)水平明显降低[SMD=-2.94,95%CI(-4.54,-1.33),P=0.000 3];白细胞介素(IL)-6水平明显降低[SMD=-3.52,95%CI(-4.72,-2.33),P<0.000 01];脂多糖(LPS)水平明显降低[SMD=-1.00,95%CI(-1.68,-0.316),P=0.004];肿瘤坏死因子(TNF-α)水平明显降低[SMD=-1.71,95%CI(-2.55,-0.86),P<0.000 01];IL-10水平明显降低[SMD=-0.56,95%CI(-1.11,-0.02),P=0.04];凝血酶原时间(PT)显著延长[SMD=1.54,95%CI(0.52,2.56),P=0.003];活化部分促凝血酶原激酶时间(APTT)延长[MD=4.88,95%CI(3.29,6.46),P<0.000 01];纤维蛋白原(FIB)水平明显降低[MD=-1.50,95%CI(-1.72,-1.28),P<0.000 01];D二聚体(DD)水平明显降低[MD=-146.16,95%CI(-171.40,-120.92),P<0.000 01];上述差异均具有统计学意义(P<0.05)。[结论]血必净联合乌司他丁治疗烧伤脓毒症患者可明显改善CRP、IL-6、IL-10、LPS以及TNF-α等炎性因子水平,同时可以明显改善PT、APTT、FIB、D-D等凝血指标,减轻烧伤后脓毒症全身炎性反应的同时改善血液高凝状态,疗效显著,值得临床推广和应用。

[Objective] To systematically evaluate and discuss the clinical efficacy of Xuebijing combined with ulinastatin in the treatment of burn sepsis. [Methods] Chinese knowledge network,VIP database,Wanfang digital periodical,Chinese biomedical literature database,PubMed and Cochrane library full text database were retrieved. The retrieval years were all from the building to April 2018 and were searched and included in the randomized pairs of the clinical efficacy of Xuebijing combined with ulinastatin in the treatment of patients with burn sepsis.,Evaluated the quality of the included literatures according to the Cochrane risk bias assessment tool. RevMan5.3 analysis was used for Meta-analysis. Results a total of 9 randomized controlled clinical trials were included,of which 308 patients in the treatment group were treated with Xuebijing combined with ulinastatin on the basis of conventional treatment such as burn shock,fluid resuscitation,anti-infection and nutritional support,and 301 patients in the control group were given the same routine treatment regimen as the treatment group. [Results] Compared with the control group,there was no significant difference in the level of calcitonin(PCT) in the treatment group(SMD=-1.70,95%CI=-3.65^-0.26,P=0. 09),and the level of C reactive protein(CRP) in the treatment group was significantly lower(SMD=-2.94,95%CI=-4.54^-1.33),and the level of interleukin decreased significantly. Low(SMD=-3.52,95%CI=-4.72^-2.33,P<0.000 01);the level of lipopolysaccharide(LPS) decreased(SMD=-1.00,95%CI=-1.68^-0.316,P=0.004),and the level of tumor necrosis factor(TNF-α) decreased significantly(SMD =-1.71,95% CI =0.04);prothrombin time(PT) prolonged significantly(SMD=1.54,95%CI= 0.52~2.56,P=0.003);activated partial prothrombin kinase time(APTT) prolonged(MD=4.88,95%CI=3.29~6.46,P<0.000 01);fibrinogen(FIB) level decreased significantly(MD =-1.50,95% CI(-1.72 ^-1.28),P <0.000 01);D-Dimer(DD)level significantly decreased significantly(MD=-146.16,95%CI=-171.40^-120.92,P<0.000 01);the above differences were statistically significant(P<0.05). [Conclusion] Xuebijing combined with ulinastatin can improve the levels of inflammatory factors such as CRP,IL-6,IL-10,LPS and TNF-alpha in patients with burn sepsis,and can obviously improve the blood coagulation indexes such as PT,APTT,FIB and D-D,alleviate the systemic inflammatory reaction of sepsis after burn and improve the hypercoagulable state of the blood,which is worthy of a significant effect. Clinical popularization and application.