血管升压素治疗心脏外科术后血管扩张性休克效果的Meta分析  

The effect of vasopressin on vasodilatory shock in patients after cardiac surgery:a Meta-analysis

作　　者：李文哲 潘鹏飞[2] 崔建 李祥 于湘友[2] Li Wenzhe;Pan Pengfei;Cui Jian;Li Xiang;Yu Xiangyou(Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普通外科,200011 [2]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054

出　　处：《中华重症医学电子杂志》2020年第3期301-307,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：新疆维吾尔自治区高校科研计划项目(XJEDU2018I011)。

摘　　要：目的探讨血管升压素对心脏外科术后血管扩张性休克患者的治疗价值。方法检索中国知网、万方医学数据库、PubMed数据库、Embase数据库、Springer Link数据库、Cochrane图书馆等关于应用血管升压素治疗心脏外科术后血管扩张性休克患者的随机对照临床试验(RCT)。检索时限为1980年1月至2018年12月。主要结局指标:病死率;次要观察指标为ICU住院时间、平均动脉压(MAP)、严重不良事件发生率、心房颤动发生率。由2名研究者分别进行文献筛选、数据提取和质量评价。应用RevMan 5.3软件进行Meta分析,绘制漏斗图分析各研究间的发表偏倚。结果共检索出相关文献458篇,根据纳入和排除标准,最终纳入4项RCT研究,共计458例患者;其中1项研究被认为偏倚风险较低,3项研究存在中度偏倚风险。Meta分析结果显示:与对照组相比,血管升压素不能显著改善心脏外科术后血管扩张性休克患者的病死率[伏势比(OR)=0.95,95%CI:0.55~1.64,P=0.85]及ICU住院时间[均数差(MD)=-0.41,95%CI:-1.40~0.57,P=0.41];可以提升患者的平均动脉压(MAP)(MD=7.77,95%CI:2.59~12.94,P=0.003);不增加患者严重不良事件的发生率(OR=0.89,95%CI:0.49~1.60,P=0.69);有降低患者心房颤动发生率的趋势,但差异无统计学意义(OR=0.19,95%CI:0.03~1.04,P=0.06)。结论现有证据表明,血管升压素不能显著改善心脏外科术后血管扩张性休克患者的病死率和ICU住院时间,但有助于改善患者的MAP且可能会降低其心房颤动的发生率。Objective To investigate the therapeutic effect of vasopressin on vasodilatory shock in patients after cardiac surgery.Methods All randomized controlled clinical trials(RCTs)of vasopressin in the treatment of vasodilatory shock patients from January 1980 to December 2018 were retrieved from CNKI,Wanfang,PubMed,Embase,Springer Link,Cochrane Library,etc.The primary outcome measure was mortality rate,and secondary outcome indicators were length of stay in intensive care unit(ICU),mean arterial pressure(MAP),and incidence of serious adverse events and atrial fibrillation.Literature screening,data extraction,and quality evaluation were conducted by two researchers independently.Meta-analysis was performed with RevMan 5.3 software.Funnel plot was used to analyze the publication bias.Results A total of 458 related articles were retrieved.According to the inclusion and exclusion criteria,four RCT studies were finally included,with a total of 458 patients.One study was considered to have a lower risk of bias and three had a moderate risk of bias.The meta-analysis showed that vasopressin did not significantly improve the mortality of vasodilatory shock patients after cardiac surgery(odds ratio[OR]=0.95,95%confidence interval[CI]:0.55-1.64,P=0.85)and length of stay in ICU(mean difference[MD]=-0.41,95%CI:-1.40-0.57,P=0.41)compared with the control group,improved the patient's MAP(MD=7.77,95%CI:2.59-12.94,P=0.003),and did not increase the incidence of severe adverse events(OR=0.89,95%CI:49-1.60,P=0.69).Although vasopressin had a tendency to decrease the incidence of atrial fibrillation,there was no statistical difference(OR=0.19,95%CI:0.03-1.04,P=0.06).Conclusion The available evidence suggests that vasopressin could not significantly improve mortality and the length of stay in ICU in patients with vasodilator shock after cardiac surgery,but it may improve MAP and reduce the incidence of atrial fibrillation.

关 键 词：心脏手术 心肺转流 血管扩张性休克 血管升压素 去甲肾上腺素 

分 类 号：R654.2[医药卫生—外科学]