生脉注射液治疗脓毒症休克效果的系统评价和Meta分析  

Effect of Shengmai Injection on Septic Shock,a Systematic Review and Meta-analyse

作　　者：哈雁翔 王晓鹏[1,2] 黄坡 张瑞 徐霄龙[2,3] 李博[2,3] 刘清泉 Ha Yanxiang;Wang Xiaopeng;Huang Po(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]首都医科大学附属北京中医医院,北京100010 [3]北京市中医研究所,北京100010

出　　处：《中国中医急症》2019年第11期1893-1898,1915,共7页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81603364,81673934);北京市自然科学基金项目(7192083)

摘　　要：目的探讨生脉注射液合并常规西医治疗对脓毒症休克患者病死率、休克和血乳酸水平的治疗效果。方法检索pubmed、Embase、cochrane、SinoMed、中国知网、万方和维普数据库,纳入用生脉注射液合并常规西医治疗对比常规西医疗法治疗成人脓毒症休克患者,以病死率、休克纠正无效数和血清乳酸水平为结局指标,提取并合并数据。使用Cochrane协作网偏倚风险评估工具进行单个研究的质量评价,使用GRADE证据质量分级系统进行单个结局指标的质量评价,使用Revman5.3软件进行数据分析、检验异质性,根据异质性选取固定效应模型或随机效应模型。结果共纳入17篇随机对照试验文献报道,860例患者。Meta分析结果显示生脉注射液对28 d病死率(RR=0.86,95%CI=[0.49,1.51],P=0.59)、7 d病死率(RR=1.08,95%CI=[0.53,2.19],P=0.84)和3 d病死率(RR=0.99,95%CI=[0.56,1.75],P=0.97)均没有统计学差异;但可减少休克治疗无效数(RR=0.25,95%CI=[0.15,0.42],P<0.0001)并降低12 h(MD=-0.69,95%CI=[-0.98,-0.40],P<0.001)、24 h(MD=-0.79,95%CI=[-1.16,-0.41],P<0.0001)、72 h(MD=-3.10,95%CI=[-5.02,-1.18],P=0.002)血乳酸浓度。结论在治疗脓毒症时,在常规西医治疗的基础上合并生脉注射液可以提高休克复苏疗效、降低血清乳酸浓度,但是对病死率没有明显改善。以上结论尚需高质量研究进一步证明,且生脉注射液使用方法和剂量有待规范。Objective:To investigate the curative effect of Shengmai Injection combined with routine therapy on the mortality,shock and blood lactic acid level of septic shock patients.Methods:PubMed,EMBASE,Cochrane,Sinomed,CNKI,Wanfang and VIP databases were searched for adult septic shock patients treated with Shengmai Injection combined with conventional western medicine compared with those treated with conventional western med icine.The mortality,the number of ineffective shock correction and the level of serum lactate were used as out come indexes.The bias risk assessment tool of Cochrane collaborative network was used to evaluate the quality of a single study,the grade evidence quality grading system to evaluate the quality of a single outcome index.Rev man 5.3 software was used to analyze data and test heterogeneity.Fixed effect model or random effect model was selected according to heterogeneity.Results:17 RCTs and 860 patients were included.Meta-analysis results showed that there was no significant difference in 28-day mortality rate(RR=0.86,95%CI=[0.49,1.51],P=0.59),7-day mortality(RR=1.08,95%CI=[0.53,2.19],P=0.84)and 3-day mortality(RR=0.99,95%CI=[0.56,1.75],P=0.97).However,it can reduce the number of ineffective shock treatment(RR=0.25,95%CI=[0.15,0.42],P<0.0001)and reduce the blood lactate concentration in 12 hours(MD=-0.69,95%CI=[-0.98,-0.40],P<0.001),24 hours(MD=-0.79,95%CI=[-1.16,-0.41],P<0.0001)and 72 hours(MD=-3.10,95%CI=[-5.02,-1.18],P=0.002).Conclusion:In the treatment of sepsis,Shengmai Injection on the basis of conventional Western medicine treatment can improve the effect of shock resuscitation and reduce serum lactate concentration,but there is no sig nificant improvement in mortality.The above conclusions need further proof of high quality research,and the meth od and dosage of Shengmai Injection need to be standardized.

关 键 词：脓毒症休克 生脉注射液 病死率 血乳酸 META分析 

分 类 号：R631[医药卫生—外科学]