西维来司钠对急性肺损伤与急性呼吸窘迫综合征预后影响的Meta分析  

Effect of sivelestat sodium on the prognosis of patients with acute lung injury and acute respiratory distress syndrome：a meta-analysis

作　　者：夏海发[1,2] 孙志鹏[1,2] 杨依依[1,2] 尚游[3] 姚尚龙[1,2] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉与重症医学研究所,湖北武汉430022 [2]华中科技大学同济医学院附属协和医院麻醉科,湖北武汉430022 [3]华中科技大学同济医学院附属协和医院ICU,湖北武汉430022

出　　处：《中华危重病急救医学》2015年第10期800-804,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81372036）

摘　　要：目的：系统评价西维来司钠对急性肺损伤/急性呼吸窘迫综合征（ALI /ARDS）患者预后的影响。方法通过计算机检索美国国立医院图书馆PubMed、EBSCO、Springer、Ovid、万方数据库、中国知网CNKI和中国生物医学文献数据库（CBM）等，纳入1985年至2014年12月发表的关于西维来司钠对ALI /ARDS患者预后影响的随机对照试验（RCT）。治疗组持续静脉输注西维来司钠，对照组不用药或者持续静脉输注生理盐水。观察指标为28 d病死率、机械通气时间、重症加强治疗病房（ICU）住院时间、第3天氧合指数。按Cochrane系统评价方法对纳入文献进行资料提取和质量评价，采用RevMan 5.3软件进行Meta分析。用漏斗图评价各研究发表偏倚。结果共纳入5篇RCT研究780例患者，其中西维来司钠组389例，对照组391例。Meta分析结果显示：与对照组相比，西维来司钠并不能降低患者28 d病死率〔优势比（OR）＝0.91，95%可信区间（95%CI）＝0.66～1.26，P＝0.58〕，机械通气时间与ICU住院时间也无明显缩短〔均数差（MD）＝-0.02，95%CI＝-0.29～0.24，P＝0.87；MD＝-9.63，95%CI＝-23.24～4.08，P＝0.17〕，但第3天氧合指数可明显改善（MD＝0.88，95%CI＝0.39～1.36，P＝0.0004）。漏斗图显示各研究的发表偏倚不大。结论西维来司钠不能降低ALI /ARDS患者28 d病死率，也不能缩短机械通气时间和ICU住院时间，但能明显改善患者早期氧合指数。ObjectiveTo investigate the effect of sivelestat sodium on the prognosis in patients with acute lung injury （ALI） and acute respiratory distress syndrome （ARDS）.Methods Databases including PubMed, EBSCO, Springer, Ovid, Wanfang data, CNKI and China Biology Medicine （CBM） were searched to identify randomized controlled trials （RCTs） regarding sivelestat sodium treatment for ALI/ARDS published from 1985 to December 2014. The patients in treatment group received intravenous infusion of sivelestat sodium, and those in control group received normal saline. The items for analysis were 28-day mortality, duration of mechanical ventilation, length of intensive care unit （ICU） stay, and oxygenation index on day 3. According to the evaluation method of Cochrane system, data extraction and quality assessment from the literature were carried out. Meta-analysis was performed using RevMan 5.3. The publication bias was analyzed with funnel plot.Results Five RCTs with a total of 780 participants were included, with 389 patients in sivelestat sodium group, and 391 in control group. Meta analysis showed： compared with control group, sivelestat sodium could not lower the 28-day mortality [odds ratio （OR） = 0.91, 95% confidence interval （95%CI） =0.66-1.26,P = 0.58], or shorten the duration of mechanical ventilation or length of ICU stay [duration of mechanical ventilation： mean difference （MD） = -0.02, 95%CI = -0.29 to 0.24,P = 0.87; length of ICU stay：MD = -9.63, 95%CI =-23.34 to 4.08,P = 0.17], but it could improve oxygenation index on day 3 （MD = 0.88, 95%CI = 0.39 to 1.36, P = 0.000 4）. Heterogeneity was not significant for the main analysis and no publication bias was shown on funnel plot. Conclusion Sivelestat sodium gave rise to a better oxygenation on day 3, but did not change the length of mechanical ventilation and ICU stay, and it did not improve 28-day mortality in ALI and ARDS.

关 键 词：西维来司钠 急性肺损伤 急性呼吸窘迫综合征 META分析 

分 类 号：R563.8[医药卫生—呼吸系统]