早期目标导向治疗对脓毒性休克患者预后影响的荟萃分析

Effect of early goal-directed therapy on the prognosis of patients with septic shock: a Meta-analysis

目的:评估早期目标导向治疗(EGDT)对急诊脓毒性休克患者预后的影响。方法:联机检索MEDLINE、Embase、Web of Science等英文数据库,收集2001-11—2018-10期间脓毒性休克患者实施EGDT的英文临床随机对照研究(RCT),按纳入与排除标准选择文献,采用RevMan 5.0软件对数据进行荟萃分析。结果:共纳入4篇RCT,入选患者4 001例,其中EGDT组1 988例,常规治疗组2 013例。EGDT组和常规治疗组住院病死率分别是20.2%和21.7%(OR=0.91,95%CI 0.76～1.08,P=0.29);28 d病死率分别是20.1%和22.0%(OR=0.89,95%CI 0.75～1.06,P=0.19);60 d病死率分别是30.0%和26.5%(OR=0.92,95%CI 0.70～1.20,P=0.52);90 d病死率分别是24.8%和25.0%(OR=0.99,95%CI 0.85～1.15,P=0.87)。结论:EGDT不改善脓毒性休克患者预后。

Objective:To evaluate the prognostic impact of early goal-directed therapy(EGDT)on patients with emergency septic shock.Method:MEDLINE,Embase,Web of Science and other online English databases were searched.The randomized controlled trials(RCTs)of patients with septic shock in EGDT from November 2001 to October 2018 were collected,and literatures according to inclusion and exclusion criteria were selected.Meta-analysis of the data was performed using RevMan 5.0 software.Result:A total of 4 RCTs were included,and 4 001 patients were enrolled.Among them,there were 1988 cases in the EGDT group and 2013 cases in the Usual-Care group.The hospital mortality rates in the EGDT group and the Usual-Care group were 20.2%and 21.7%,respectively(OR=0.91,95%CI 0.76-1.08,P=0.29);the 28-day mortality rates were 20.1%and 22.0%,respectively(OR=0.89,95%CI 0.75-1.06,P=0.19);60-day mortality were 30.0%and 26.5%(OR=0.92,95%CI 0.70-1.20,P=0.52);90-day mortality were 24.8%and 25.0%,respectively(OR=0.99,95%CI 0.85-1.15,P=0.87).Conclusion:EGDT does not improve the prognosis of patients with septic shock.