左西孟旦对脓毒症患者预后及循环功能影响的Meta分析

The effects of levosimendan on prognosis and circulatory function of sepsis patients: a Meta-analysis

目的 评价左西孟旦对脓毒症患者预后及循环功能的影响.方法 以'脓毒症'或'严重脓毒症'或'脓毒性休克'和'左西孟旦'为中文关键词,以'simendan'或'levosimendan'和'sepsis'或 'severe sepsis'或'sepsis shock'或'septic shock'或'septic'或'shock'为英文关键词,检索中国知网(CNKI)、维普数据库、万方数据库、中国生物医学文献数据库(CBM)、美国国立医学图书馆数据库(Pubmed)、荷兰医学文摘(Embase)、Cochrane 图书馆等数据库,收集国内外公开发表的关于左西孟旦对脓毒症预后及循环功能影响的中英文文献,检索时间范围为各数据库建库至2017年5月.采用改良Jadad评分进行文献质量评价,应用RevMan 5.3 软件进行Meta 分析;采用漏斗图分析发表偏倚.结果 共纳入18篇文献,中文文献9篇,英文文献9篇;9篇高质量,9篇低质量;对照组688例,试验组704例.Meta分析显示,试验组与对照组病死率比较差异无统计学意义〔相对危险度(RR)=0.92,95%可信区间(95%CI)=0.80~1.06,P=0.27〕;与对照组比较,试验组患者重症加强治疗病房(ICU)住院时间缩短〔均数差(MD)=-2.02,95%CI=-2.90^-1.13,P<0.00001),心排血指数增加(MD=0.63,95%CI=0.39~0.87,P<0.00001),血乳酸水平降低(MD=-1.37,95%CI=-1.51^-1.23,P<0.00001).漏斗图评价显示,发表文献可能存在一定的偏倚.结论 左西孟旦可改善脓毒症患者的循环功能,减少ICU住院时间,但不能降低病死率.

Objective To evaluate the effect of levosimendan on prognosis and circulation disorders of sepsis patients. Methods With the guidance of these following Chinese or English key words, such as sepsis, severe sepsis, septic shock, simendan, levosimendan, etc., some of Chinese and foreign published literatures on randomized controlled trials (RCTs) concerning the effects of levosimendan on the prognosis and circulatory function of septic patients were searched through China National Knowledge Infrastructure (CNKI) internet, VIP and Wanfang Databases, China Biomedicine Database (CMB), Pubmed in American National library, Holland Medical Abstract Database (Embase), Cochrane Library, etc databases, from the creation of above various databases to May 2017. The quality of the collected RCTs was evaluated by modified Jadad score; Revman 5.3 software was used to carry out Meta analysis; the publication bias was assessed by the funnel plots. Results A total of 18 RCTs, 9 in Chinese and 9 in English, but only half of the literatures were of high quality, and the other 9 of low quality, containing 688 cases in control group and 704 cases in experimental group were ultimately enrolled in this analysis. The Meta analyses showed that there was no statistical significant difference in the mortality between the experimental group and the control group [relative risk (RR) = 0.92, 95% confidence interval (95%CI) = 0.80 - 1.06, P = 0.27]; compared with control group, the time of stay in ICU was shortened [mean difference (MD) = -2.02, 95%CI = -2.90 to -1.13, P < 0.000 01], cardic output index was increased (MD = 0.63, 95%CI = 0.39 - 0.87, P < 0.000 01), and blood lactate level was decreased (MD = -1.37, 95%CI = -1.51 to-1.23, P < 0.000 01) in the experimental group, being significantly improved after levosimendan therapy. The funnel map evaluation showed that there might be a certain bias in the publication of the literature. Conclusion Levosimendan can improve circulatory disorders and reduce the time of stay in ICU for septic patients, but can not reduce their mortality.