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小剂量皮质激素治疗脓毒症休克随机对照研究的Meta分析
作者:庄燕  常宁  王醒 
单位:江苏省中医院 重症医学科,江苏 南京 210029
关键词:皮质激素 脓毒症 休克 Meta分析 
分类号:R631.4;R459.1
出版年·卷·期(页码):2013·32·第二期(213-218)
摘要:

目的:评价小剂量皮质激素对脓毒症休克治疗的效果及不良反应发生情况。方法:计算机检索Medline、Embase、ScienceDirect、Ovid、Cochrane图书馆临床随机对照试验资料库(1996年1月至2011年12月)中小剂量皮质激素治疗脓毒症休克的随机对照临床试验,按照标准筛查文献,提取资料,采用Review Manager 4.2.9对数据进行Meta分析。结果:共纳入5项随机对照研究,均为英文,共928例患者,其中治疗组共471例,对照组457例。Meta分析结果显示,小剂量皮质激素(氢化可的松用量或相当量<1 000 mg·d-1)治疗可以明显增加患者的休克逆转率(OR值为1.74,95%CI为1.06~2.85,P=0.03),但并不降低患者住院死亡率(OR值为0.77,95%CI为0.50~1.19,P=0.25),也不增加患者消化道出血发生率(OR值为1.17,95%CI为0.66~2.06,P=0.59)。结论:小剂量皮质激素治疗脓毒症休克不能降低患者住院死亡率,但可以提高休克逆转率,且不增加消化道出血发生率。

Objective: To assess the therapeutic advantages of low dose corticosteroid regimens in severe sepsis and septic shock and the complications of therapy.Methods:We systematically reviewed randomized controlled trials(RCT)(from January 1996 to December 2011) in multiple data-base(Medline,Embase,ScienceDirect,Ovid, Cochrane Central Register of Controlled trials,Cochrane database of systematic reviews)and hand search of references,reviews and scientific society proceedings.Results:Corticosteroid efficacy, compared with control,for hospital-mortality,proportion of patients experiencing shock-resolution,and gastro-intestinal bleeding were assessed using random-effects models;expressed as odds ratio(OR,95% credible-interval).There was no significant difference between two groups in hospital-mortality(OR 0.77,95%CI 0.50-1.19,P=0.25),as for the number of patients experiencing shock-resolution ,the treatment group had more proportion(OR 1.74,95%CI 1.06-2.85,P=0.03 ).There was no significant difference between the two groups in gastro-intestinal bleeding(OR 1.17,95%CI 0.66-2.06,P=0.59).Conclusion:Low dose corticosteroid does not reduce the hospital-mortality of patients with severe sepsis and septic shock,but could increase the rate of shock-resolution,neither does it increase the incidence of gastro-intestinal bleeding.

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