左西孟旦和多巴酚丁胺治疗脓毒症/ 脓毒性休克疗效与安全性的系统评价  

Efficacy and Safety of Levosimendan Versus Dobutamine in the Treatment of Sepsis and Septic Shock:A Systematic Review and A Meta-Analysis

作　　者：郭清清 林建东[1] 文剑波[2] 林浩[3] GUO Qingqing;LIN Jiandong;WEN Jianbo;LIN Hao(Department of Intensive Medicine,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Gastroenterology,JiangXi PingXiang People's Hospital,Pingxiang 337000,China;Department of Gastroenterology,Fujian Provincial Hospital South Branch,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属第一医院重症医学科,福州350005 [2]江西省萍乡市人民医院消化内科,萍乡337000 [3]福建医科大学省立临床医学院,福建省立医院南院消化内科,福州350001

出　　处：《福建医科大学学报》2021年第1期19-25,共7页Journal of Fujian Medical University

摘　　要：目的评价左西孟旦治疗脓毒症/脓毒性休克的疗效与安全性。方法计算机检索PubMed,The Cochrane Library,EMbase,Clinical Trials,CNKI,WanFang Data,CBM及VIP数据库,搜集关于左西孟旦和多巴酚丁胺治疗脓毒症/脓毒性休克的随机对照试验(RCT),将使用多巴酚丁胺的脓毒症患者作为对照组。检索时限从建库至2020年2月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析,并运用GRADE profiler软件进行证据质量等级评估。结果纳入6个研究,共186例患者。Meta分析结果显示:与多巴酚丁胺组比较,左西孟旦组患者的最长随访期死亡率[RR=1.03,95%CI(0.74~1.43),P=0.87;GRADE证据分级:低]、ICU住院时间[MD=-2.55,95%CI(-7.58~2.48),P=0.32;GRADE证据分级:极低]和血乳酸水平[MD=-0.54,95%CI(-1.25~0.03),P=0.07;GRADE证据分级:极低]无统计学差别。但左西孟旦组患者的左心室射血分数[MD=3.90,95%CI(1.09~6.71),P=0.006;GRADE证据分级:极低]和心脏指数[MD=0.32,95%CI(0.20~0.44),P<0.00001;GRADE证据分级:低]均较对照组升高,差别有统计学意义。结论与多巴酚丁胺比较,左西孟旦可以改善脓毒症/脓毒性休克患者的心脏功能,但患者的死亡率、ICU住院时间和血乳酸水平未见明显差异。Objective To systematically evaluate the efficacy and safety of levosimendan versus dobutamine in the treatment of patients with sepsis/septic shock.Methods PubMed,EMBASE,the Cochrane Library,clinical trials,CBM,CNKI,WanFang Data and VIP were searched until February 2020.Randomized controlled studies of levosimendan versus Dubatamine for the treatment of patients with sepsis or septic shock were performed by two independent researchers.The mortality of patients was considered as primary outcome.The cardiac index,left ventricular ejection fraction(LVEF),serum lactate level and length of ICU stay were taken as secondary outcomes.The meta-analysis was performed with Revman 5.3 and the evidence quality evaluation of outcomes was measured with GRADE profiler.Results A total of 6 studies with 186 patients were included in this meta-analysis.There were no statistically difference between the two groups in the mortality[RR=1.03,95%CI(0.74-1.43),P=0.87],length of ICU stay[MD=-2.55,95%CI(-7.58-2.48),P=0.32]and serum lactate levels[MD=-0.54,95%CI(-1.25-0.03),P=0.07].However,the left ventricular ejection fraction[MD=3.90,95%CI(1.09-6.71),P=0.006]and cardiac index[MD=0.32,95%CI(0.20-0.44),P<0.00001]in the levosimendan group were significantly higher than those in the dobutamine group.Conclusion Findings from this meta-analysis demonstrated that the levosimendan might improve the cardiac function of patients with sepsis/septic shock in comparison with those in the dubatamine group.Nevertheless,it did not reduce the mortality,length of ICU stay and serum lactate level in patients with sepsis.More large-scale randomised trials are necessary to validate levosimendan use in sepsis.

关 键 词：脓毒症 脓毒性休克 左西孟旦 META分析 系统评价 随机对照试验 

分 类 号：R459.7[医药卫生—急诊医学]