静脉用左西孟旦与多巴酚丁胺对急性失代偿心力衰竭患者有效性和安全性的Meta分析  

Meta-analysis about Efficacy and Safety of Intravenous Levosimendan and Dobutamine in the Treatment of Acute Decompensated Heart Failure

作　　者：任重[1] 王高明[2] 李兵[3] 杨文[3] 

机构地区：[1]武汉大学基础医学院,湖北省武汉市430071 [2]武汉大学中南医院呼吸内科 [3]湖北松滋市人民医院内一科

出　　处：《实用心脑肺血管病杂志》2012年第11期1768-1771,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析比较静脉用左西孟旦与多巴酚丁胺对急性失代偿心力衰竭患者的安全性和有效性。方法通过检索PubMed、EMbase、万方、中国知网等数据库,查找静脉用左西孟旦与多巴酚丁胺治疗急性失代偿心力衰竭的随机对照实验(RCT),检索时间为1990-01-01—2011-12-15。再按纳入标准进行RCT的筛选、资料提取和证据质量评价后,利用RevMan5.0软件进行Meta分析,利用漏斗图进行证据质量评价。结果共纳入7个研究,共334例患者。Meta分析显示:(1)有效性方面:在治疗前,LVEF没有差异〔SMD=-0.74,95%CI(-1.46.-0.01),P=0.05〕;在治疗后,左西孟旦组较多巴酚丁胺组的LVEF有了显著升高〔SMD=3.18,95%CI(2.40,3.96),P<0.00001〕。(2)安全性方面:左西孟旦组与多巴酚丁胺组所致不良反应差别不大〔SMD=0.59,95%CI(0.26,1.35),P=0.21〕。结论与多巴酚丁胺比较,左西孟旦能显著提高急性失代偿心力衰竭LVEF,改善患者临床症状,值得在临床推广使用,但两者在不良反应方面差别不大。由于纳入研究的样本数较少,多中心、大样本、双盲随机对照试验应进一步验证。Objective To evaluate the efficacy and safety of intravenous levosimendan and dobutamine in the treatment of acute decompensated heart failure.Methods Through the retrieval of PubMed,EMbase,Cochrane,Wangfang and CNKI database for randomized controlled trials（RCT） about intravenous levosimendan and dobutamine for the treatment of acute decompensated heart failure（the duration of retrieval form January 1,1990 to May 20,2012）,we performed Meta analysis by utilizing RevMan5.0 software to and assessed quality evaluation of the evidence by using funnel figure and utilized RevMan 5.0 software after the screening,data extraction,quality evaluation of RCT according to the inclusion criteria.Results There were seven studies and 334 patients to meet the inclusion criterion.Meta-analysis showed that：（1）the validity LVEF between two before treatment had no difference（SMD=-0.74,95% CI（-1.45,-0.01）,P=0.05）;but after the treatment,the levosimendan group had significantly more increased on the LVEF than the dobutamine group（SMD=3.18,95% CI（2.40,3.96）,P〈0.00001）.（2）the safety：the leosimendan group and the dobutamine group had no obvious difference on the adverse effect（SMD=0.59,95%CI（0.26,1.35）,P=0.21）.Conclusion Compared with dobutamine,the levosimendan could significantly improve LVEF of acute decompensated heart failure and improve the clinical symptoms.Thus it is deserved to be promoted in clinical practice.But both on the adverse effect hadn′t significantly different.Because the samples included in the study were less,more center,large sample,double-blind randomized controlled trials should further be performed.

关 键 词：左西孟旦 多巴酚丁胺 急性病 心力衰竭 有效性研究 安全 META分析 

分 类 号：R541.6[医药卫生—心血管疾病]