小剂量糖皮质激素治疗感染性休克疗效的meta分析

doi:10.3969/j.issn.2095-378X.2018.03.013

外科研究与新技术 ›› 2018, Vol. 7 ›› Issue (3): 197-200.doi: 10.3969/j.issn.2095-378X.2018.03.013

小剂量糖皮质激素治疗感染性休克疗效的meta分析

岑春梅¹, 蔡丰丰²

1.同济大学医学院,上海 200092;
2.同济大学附属杨浦医院乳腺外科,上海 200092

收稿日期:2018-07-17 出版日期:2018-09-28 发布日期:2019-12-16
通讯作者: 蔡丰丰(1979—),男,电子信箱:caifengfeng@tongji.edu.cn
作者简介:岑春梅(1994—),女,同济大本科在读
基金资助:
教育部留学回国人员科研启动基金资助项目(2015311);上海市杨浦区卫计生委好医师计划学科带头人项目(201742);上海市杨浦区科委中医药专项委级科研项目(YP17ZM02);上海市自然科学基金项目(18ZR1436000)

Effect of low-dose glucocorticoid on septic shock: A Meta-analysis

CEN Chunmei¹, CAI Fengfeng²

1.Tongji University School of Medicine, Shanghai 200092, China;
2.Department of Breast Surgery,Yangpu Hospital Affiliated to Tongji University, Shanghai 200092, China

Received:2018-07-17 Online:2018-09-28 Published:2019-12-16

摘要/Abstract

摘要： 目的分析小剂量糖皮质激素治疗感染性休克的临床疗效。方法以low-dose glucocorticoid、septic shock为英文检索词检索词在Medline、Embase、ScienceDirect、Ovid、Cochrane英文数据库;小剂量糖皮质激素、感染性休克、脓毒症为中文检索词在中国知网、万方数据库等中文数据库检索 (2010年1月—2017年12月)小剂量糖皮质激素治疗感染性休克的随机对照临床试验资料,按标准查文献并提取数据,用Review Manager 5.2对数据进行meta分析。结果共纳入5项415例感染性休克随机对照研究病例,其中接受小剂量糖皮质激素治疗(治疗组)208例,对照组207例。治疗组血浆乳酸浓度较对照组明显降低(P<0.001),ICU住院天数明显减少(P<0.001)。结论小剂量糖皮质激素治疗可降低感染性休克患者血浆乳酸浓度,减少患者ICU住院天数,改善患者预后。

关键词: 糖皮质激素, 感染性休克, 血浆乳酸清除

Abstract: Objective To analyze the effect of low-dose glucocorticoid on septic shock.Methods Data of randomized controlled trials (RCT) of patients with septic shock treated by low-dose glucocorticoid from January 2010 to December 2017 were systematically reviewed in databases of CNKI, Wanfang, Medline, Embase, ScienceDirect, Ovid, and Cochrane, with the searching words, in Chinese or English, such as“low-dose glucocorticoid” and “septic shock”.Data were retrieved and analyzed by Review Manager 5.2 software for Meta analysis.Results A total of 5 RCT studies involving 415 patients with septic shock were included.Of them, 208 patients were in the treatment group (receiving low-dose glucocorticoid treatment) and 207 patients were in the control group.Plasma lactate concentration was significantly decreased and ICU stay time was significantly shortened in the treatment group compared with the control group (P<0.001).Conclusion Low-dose glucocorticoid administration for patients with septic shock could decrease serum lactate concentration, shorten ICU stay time, and improve prognosis.

Key words: Glucocorticoid, Septic shock, Plasma lactate clearance

中图分类号:

R 631.4

岑春梅, 蔡丰丰. 小剂量糖皮质激素治疗感染性休克疗效的meta分析[J]. 外科研究与新技术, 2018, 7(3): 197-200.

CEN Chunmei, CAI Fengfeng. Effect of low-dose glucocorticoid on septic shock: A Meta-analysis[J]. Surgical Research and New Technique, 2018, 7(3): 197-200.

参考文献

[1] Fry DE.Sepsis, systemic inflammatory response and multiple organ dysfunction: the mystery continues[J].Am Surg, 2012, 78(1):1-8.
[2] 吴家玉.ICU感染性休克病死危险因素分析及临床对策[J].中华医院感染学杂志, 2013,23(1):30-32.
[3] Keh D, Weber-Carstens S.Adjunctive therapies in severe sepsis and septic shock:current place of steroids[J].Curr Infect Dis Rep, 2008, 10(5):354-361.
[4] Rygård S, Butler E, Granholm A, et al.Lowdose cortico-steroids for adult patients with septic shock:a systematic review with metaanalysis and trial sequential analysis[J].Intensive Care Med, 2018, 4(1):1432-1238.
[5] Zhu YH, Wen YG, Jiang QM, et al.The effectiveness and safety of corticosteroids therapy in adult critical Ill patients with septic shock:a meta-analysis of randomized controlled trials controversy in sepsis and septic shock:a meta-analysis[J].Shock, 2018, 7(1):1073-2322.
[6] Annane D, Bellissant E, Bollaert PE, et al.Corticosteroids for severe sepsis and septic shock:a systematic review and meta-analysis[J].BMJ, 2004, 329(7464):480-488.
[7] Minneci PCM, Deans KJM, Banks SMP, et al.Metaanalysis: the effect of steroids on survival and shock during sepsis depends on the dose[J].Ann Intern Med, 2004, 141(1):47-56.
[8] Sprung CL, Annane D, Keh D, et al.Hydrocortisone therapy for patients with septic shock[J].N Engl J Med, 2008, 358(2):111-124.
[9] Dellinger RP, Levy MM, Carlet JM, et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock: 2008[J].Crit Care Med, 2008, 39(2):165-228.
[10] 崔志新,陈伟杰.小剂量糖皮质激素对严重感染性休克患者乳酸清除率及预后的影响[J].实用医学杂志, 2012,28(18):3055-3057.
[11] 杨玉敏,章华萍,丁刚,等.多巴胺及去甲肾上腺素联合多巴酚丁胺对感染性休克患者早期血乳酸及肾灌注的影响[J].实用医学杂志, 2010,11(12):753-754.
[12] 李辉,王长远.乳酸和乳酸清除率对老年重症肺炎患者预后的评估[J].临床肺科杂志, 2010,15(7):927-928.
[13] 常红霞.小剂量糖皮质激素联合垂体后叶素治疗感染性休克的疗效观察[J].医学综述, 2016,22(01):164-166.
[14] Siami S, Polito A, Porcher R, et al.Thirst perception and osmoregulation of vasopressin secretion are altered during recovery from septic shock[J].PLoS One, 2013, 8(11):e80190.
[15] 张志坚,华清泉,王新春,等.全身应用联合鼓室注射糖皮质激素治疗重度和极重度突发性聋[J].听力学及言语疾病杂志, 2012,20(5):4.
[16] Volbeda M, Wetterslev J, Gluud C, et al.Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis[J]. Intens Care Med, 2015, 41(7):1220-1234.
[17] Meduri GU, Schwingshackl A, Hermans G.Prolonged gluco-corticoid treatment in ARDS: impact on intensive care unit-acquired weakness[J].Front Pediatr, 2016, 4(1):69.
[18] Arabi YM, Aljumah A, Dabbagh O, et al.Low-dose hydro-cortisone in patients with cirrhosis and septic shock:a randomized controlled trial[J].Can Med Assoc J, 2010, 182(18):1971-1977.

小剂量糖皮质激素治疗感染性休克疗效的meta分析

Effect of low-dose glucocorticoid on septic shock: A Meta-analysis

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