单次剂量依托咪酯对重症患者预后的影响：系统性回顾及Meta分析  

Effects of single-dose etomidate on prognosis of critical patients： a systematic review and Meta-analysis

作　　者：高晓薇[1] 曹亚楠[1] 李曼[1] 王锷[1] Gao Xiaowei;Cao Yanan;Li Man;Wang E(Department of A nesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《国际麻醉学与复苏杂志》2018年第5期447-453,462,共8页International Journal of Anesthesiology and Resuscitation

摘　　要：目的 系统评价单次剂量依托咪酯对重症患者病死率和肾上腺功能不全发生率的影响。 方法 系统检索PubMed、EMBASE、Medline、Web of Science、the Cochrane Library、中国知网、万方数据库和维普数据库，收集单次剂量依托咪酯对重症患者病死率和肾上腺功能不全发生率影响的文献。按照纳入和排除标准，由两位研究员独立选择文献、提取资料，然后采用RevMan 5.3软件进行Meta分析。采用随机效应建模的Mantel-Haenszel方法计算合并相对危险度（relative risk， RR）和95％CI。 结果 纳入5篇随机对照试验（randomized controlled trial， RCT）及21篇观察性研究文献，共26篇，包括7 430例患者。Meta分析结果显示：单次剂量依托咪酯不增加重症患者病死率，其中 RCT的RR=1.16, 95%CI为（0.93，1.45）（P＞0.05）；观察性研究文献的RR=1.07，95%CI为（1.00，1.14）（P=0.05）。观察性研究的所有亚组分析结果与观察性试验分析结果一致。单次剂量依托咪酯增加重症患者肾上腺功能不全发生率，其中 RCT的RR=1.61，95%CI为（1.06，2.46）（P＜0.01）；观察性研究文献的RR=1.35，95%CI为（1.16，1.57）（P＜0.01）。 结论 单次剂量依托咪酯不增加重症患者病死率，但增加重症患者相对肾上腺功能不全发生率。上述结论主要依据观察性研究的数据，有可能存在选择偏倚，因此更多高质量 RCT文献的纳入是有必要的。Objective To evaluate the effects of single-dose etomidate on the mortality and the risk of adrenal insufficiency in patients with critical illness. Methods PubMed, EMBASE, Medline, Web of Science, the Cochrane Library, CNKI, Wanfang Database, and Vip Database were searched for the relevant randomized controlled clinical trials and observational studies. According to the inclusion and exclusion criteria, two researchers independently selected the literature, extracted the data, and then performed Meta-analysis usinge RevMan5.3 software. The Mantel-Haenszel method with the random-effects modeling was used to calculate pooled relative risks （RR） and 95%CI. Results Twenty-six studies [5 randomized controlled trial（RCT） and 21 observational studies] involving 7 430 patients were qualified. Pooled analysis suggested that etomidate was not associated with increased mortality in critical patients [RCT：RR=1.16, 95%CI（0.93, 1.45）, P〉0.05] [observational studies：RR=1.07, 95%CI（1.00, 1.14）（P=0.05）]. These findings were also consistent across all subgroup analyses off observational studies. Etomidate increased the risk of adrenal insufficiency in critical patients[RCT：RR=1.61, 95%CI（1.06, 2.46）（P〈0.01）] [observational studies：RR=1.41, 95%CI（1.22, 1.62）（P〈0.01）]. Conclusions Current evidence indicates that single-dose etomidate does not increase the mortality, but increases the risk of adrenal insufficiency in critical patients. However, this finding largely relies on data from observational studies and is potentially subject to selection bias. Therefore, high-quality and adequately powered RCT are warranted.

关 键 词：依托咪酯 重症患者 病死率 肾上腺功能不全 META分析 

分 类 号：R614[医药卫生—麻醉学]