小剂量皮质激素治疗脓毒症休克随机对照研究的Meta分析  

Role of low dose corticosteroids in severe sepsis and septic shock:a Meta-analysis

作　　者：庄燕[1] 常宁[1] 王醒[1] 

机构地区：[1]江苏省中医院重症医学科,江苏南京210029

出　　处：《东南大学学报（医学版）》2013年第2期213-218,共6页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:评价小剂量皮质激素对脓毒症休克治疗的效果及不良反应发生情况。方法:计算机检索Medline、Embase、ScienceDirect、Ovid、Cochrane图书馆临床随机对照试验资料库(1996年1月至2011年12月)中小剂量皮质激素治疗脓毒症休克的随机对照临床试验,按照标准筛查文献,提取资料,采用ReviewManager 4.2.9对数据进行Meta分析。结果:共纳入5项随机对照研究,均为英文,共928例患者,其中治疗组共471例,对照组457例。Meta分析结果显示,小剂量皮质激素(氢化可的松用量或相当量<1 000 mg.d-1)治疗可以明显增加患者的休克逆转率(OR值为1.74,95%CI为1.06～2.85,P=0.03),但并不降低患者住院死亡率(OR值为0.77,95%CI为0.50～1.19,P=0.25),也不增加患者消化道出血发生率(OR值为1.17,95%CI为0.66～2.06,P=0.59)。结论:小剂量皮质激素治疗脓毒症休克不能降低患者住院死亡率,但可以提高休克逆转率,且不增加消化道出血发生率。Objective： To assess the therapeutic advantages of low dose corticosteroid regimens in severe sepsis and septic shock and the complications of therapy.Methods：We systematically reviewed randomized controlled trials（RCT）（from January 1996 to December 2011） in multiple data-base（Medline,Embase,ScienceDirect,Ovid, Cochrane Central Register of Controlled trials,Cochrane database of systematic reviews）and hand search of references,reviews and scientific society proceedings.Results：Corticosteroid efficacy, compared with control,for hospital-mortality,proportion of patients experiencing shock-resolution,and gastro-intestinal bleeding were assessed using random-effects models;expressed as odds ratio（OR,95% credible-interval）.There was no significant difference between two groups in hospital-mortality（OR 0.77,95%CI 0.50-1.19,P=0.25）,as for the number of patients experiencing shock-resolution ,the treatment group had more proportion（OR 1.74,95%CI 1.06-2.85,P=0.03 ）.There was no significant difference between the two groups in gastro-intestinal bleeding（OR 1.17,95%CI 0.66-2.06,P=0.59）.Conclusion：Low dose corticosteroid does not reduce the hospital-mortality of patients with severe sepsis and septic shock,but could increase the rate of shock-resolution,neither does it increase the incidence of gastro-intestinal bleeding.

关 键 词：皮质激素 脓毒症 休克 META分析 

分 类 号：R631.4[医药卫生—外科学] R459.1[医药卫生—临床医学]