多巴胺与去甲肾上腺素治疗感染性休克患者安全性的Meta分析  

Meta-analysis of safety of dopamine versus norepinephrine for patients with septic shock

作　　者：王玉华[1] 颊建臣[1] 杨艳莉[1] 康勉利[1] 张益锋[1] 

机构地区：[1]河南科技大学第一附属医院急诊科,河南洛阳471000

出　　处：《中国现代医学杂志》2014年第7期51-55,共5页China Journal of Modern Medicine

摘　　要：目的对多巴胺与去甲肾上腺素治疗严重感染性休克病人的安全性进行分析。方法系统检索PubMed和Embase,考克兰随机对照试验及中国知网等电子数据库,纳入对比多巴胺与去甲肾上腺素治疗感染性休克病人的随机对照试验。结果共纳入7项随机对照试验,总计1 456名病人。去甲肾上腺素组病人住院期间死亡风险明显低于多巴胺组（RR=1.11,95%CI：1.00-1.23,P=0.04）。去甲肾上腺素组病人发生心律失常风险明显低于多巴胺组（RR=2.31,95%CI：1.39-3.86,P=0.001）。两组病人用药后平均动脉压无明显差异（SMD=-0.58,95%CI：-1.75~0.60,P=0.34）。结论目前现有的证据表明,相比于多巴胺,去甲肾上腺素治疗感染性休克病人在安全性问题上具有明显的优势。因此,可以考虑将去甲肾上腺素作为感染性休克病人的首选用药。然而,对待我们的结论需要谨慎,因为,本荟萃分析纳入研究的样本总量较小。多巴胺对比去甲肾上腺素治疗感染性休克病人的安全性问题需要将来纳入更多的随机对照试验进行更深入的研究和探讨。[Objective] This meta-analysis was conducted to evaluate the safety of dopamine versus nore- pinephrine in the treatment of critically ill patients with septic shock. [Methods] PubMed, Embase, the Coehrane Controlled Trials Register, and the China National Knowledge Infrastructure electronic databases were systematically searched to identify randomized controlled trails compared dopamine with norepinephrine for patients with septic shock. [ Results] A total of 1456 patients from seven randomized controlled trials were subjected to meta-analysis. Norepinephrine group significantly decreased the in-hospital mortality compared with the dopamine group （RR=1.11, 95% CI： 1.00-1.23, P =0.04）. We also found a statistically significant decrease in the rate of cardiac arrhythmias in the norepinephrine group compared to the dopamine group （RR=2.31, 95% CI： 1.39-3.86, P =0.001）. These two groups showed no difference in mean artery pressure （SMD=-0.58, 95% CI： -1.75-0.60, P =0.34）. [ Conclusions] Current limited evidence suggested that norepineprine shows beneficial effect on the safety in the treatment of septic shock; thus, norepinephrine may be suggested as the first choice for patients with septic shock. However, the result of our meta-analysis should be interpreted with caution because of the low power. More randomized controlled trails should focus on the safety and effectiveness of dopamine versus norepinephrine for septic shock.

关 键 词：多巴胺 去甲肾上腺素 感染性休克 随机对照试验 荟萃分析 

分 类 号：R639[医药卫生—外科学]