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中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (04) : 252 -257. doi: 10.3877/cma.j.issn.1674-6880.2017.04.008

所属专题： 文献；

荟萃分析

左西孟旦对严重脓毒症/脓毒性休克患者病死率影响的Meta分析
周小洋1, 许兆军1,†(), 刘鹏1, 张玉楚1, 杨群1, 胡旭军1, 陈培服1   
  1. 1. 315000　浙江宁波，宁波市第二医院重症医学科
  • 收稿日期:2017-06-20 出版日期:2017-08-01
  • 通信作者: 许兆军
  • 基金资助:
    宁波市自然科学基金项目(2016A610139)

Effect of levosimendan on the overall mortality in patients with severe sepsis or septic shock: a meta-analysis

Xiaoyang Zhou1, Zhaojun Xu1,†(), Peng Liu1, Yuchu Zhang1, Qun Yang1, Xujun Hu1, Peifu Chen1   

  1. 1. Department of Critical Care Medicine, Ningbo No.2 Hospital, Ningbo 315000, China
  • Received:2017-06-20 Published:2017-08-01
  • Corresponding author: Zhaojun Xu
  • About author:
    Corresponding author: Xu Zhaojun, Email: guest666666@163.com
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周小洋, 许兆军, 刘鹏, 张玉楚, 杨群, 胡旭军, 陈培服. 左西孟旦对严重脓毒症/脓毒性休克患者病死率影响的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2017, 10(04): 252-257.

Xiaoyang Zhou, Zhaojun Xu, Peng Liu, Yuchu Zhang, Qun Yang, Xujun Hu, Peifu Chen. Effect of levosimendan on the overall mortality in patients with severe sepsis or septic shock: a meta-analysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(04): 252-257.

目的

系统评价左西孟旦对严重脓毒症或脓毒性休克患者病死率的影响。

方法

计算机检索PubMed、OVID、Cochrane临床试验数据库、万方数据库、中国知网数据库、维普网及中国生物医学文献数据库自建库至2016年12月期间关于左西孟旦治疗（实验组）与传统治疗（对照组）对成人严重脓毒症或脓毒性休克患者病死率影响的随机对照试验。由2名研究者按照纳入及排除标准独立进行文献筛选、提取和质量评估后，使用Stata/SE 11.0软件合并效应量行Meta分析，并绘制漏斗图检测发表偏倚。

结果

共纳入10篇符合入选标准的文献，共831例患者。Meta分析显示，与对照组比较，实验组对严重脓毒症或脓毒症休克患者的病死率并无明显下降[OR = 0.95，95%CI（0.71，1.27），Z = 0.36，P = 0.721]，漏斗图显示各研究间存在发表偏倚。同时，两组患者住ICU时长比较，差异亦无统计学意义[SMD = -0.24，95%CI（-0.56，0.07），Z = 1.51，P = 0.131]。

结论

左西孟旦不能降低严重脓毒症或脓毒性休克患者的病死率。

关键词: 左西孟旦, 脓毒症, 休克，脓毒性, 病死率, Meta分析
Objective

To assess the effect of levosimendan on the overall mortality in patients with severe sepsis or septic shock.

Methods

Randomized controlled trials focused on the effects of levosimendan treatment (experiment group) and traditional treatment (control group) on the overall mortality in adult patients with severe sepsis or septic shock were systematically retrieved from PubMed, OVID, Cochrane Library, Wanfang data, CNKI, VIP net and Chinese Biomedical Database from database inception to December 2016. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted the data and evaluated the quality of the included studies. The mate-analysis was performed by Stata/SE 11.0 software, funnel plots were drawn to detect the publication bias.

Results

A total of 831 patients in 10 studies were included. Meta-analysis indicated that the overall mortality in the experiment group showed no significant difference as compared to the control group [OR = 0.95, 95%CI (0.71, 1.27), Z = 0.36, P = 0.721], the funnel plots demonstrated publication bias. Meanwhile, there was also no significant difference in the duration of intensive care unit stay between the two groups [SMD =-0.24, 95%CI (-0.56, 0.07), Z = 1.51, P = 0.131].

Conclusion

Levosimendan can't improve the overall mortality in patients with severe sepsis or septic shock.

Key words: Levosimendan, Sepsis, Shock, speptic, Mortality, Meta-analysis
表1 纳入文献的基本资料
纳入文献 样本量（例） 年龄[ ± s或M（P25，P75）] 性别[例（男/女）] APACHEⅡ评分[分， ± s或M（P25，P75）] Jadad评分（分）
实验组 对照组 实验组 对照组 实验组 对照组 实验组 对照组
Gordon等2016[7] 258 256 67（58，75） 69（58，77） 145/113 144/112 25（21，31） 25（21，30） 7
Meng等2016[8] 19 19 55 ± 18 50 ± 14 13/6 11/8 18.4 ± 4.5 19.5 ± 4.3 4
Torraco等2014[5] 13 13 70（58，80） 68（57，79） 11/2 8/5 - - 1
Memis等2012[11] 15 15 55 ± 19 56 ± 15 8/7 8/7 30.1 ± 7.6 27.0 ± 8.5 1
Morelli等2010[12] 20 20 68（55，74） 66（54，78） 14/6 13/7 - - 4
Morelli等2005[13] 15 15 61.5 ± 7.0 62 ± 7 11/4 12/3 24.4 ± 1.6 23.7 ± 2.1 3
黄河等2015[14] 26 25 66 ± 3 66 ± 5 15/11 15/10 23.7 ± 6.8 24.5 ± 6.9 1
方明星等2014[15] 18 18 61 ± 7 62 ± 7 14/4 13/5 23.5 ± 2.4 24.1 ± 2.1 3
刁井地等2014[16] 19 19 - - - - 19.6 ± 5.9 20.3 ± 4.8 1
赵湛元2013[17] 15 15 - - - - - - 1
图1 左西孟旦对严重脓毒症/脓毒性休克患者病死率影响的森林图
图2 左西孟旦对严重脓毒症/脓毒性休克患者住ICU时长影响的森林图
图3 左西孟旦对严重脓毒症/脓毒性休克患者病死率影响的Meta分析文献发表偏倚漏斗图
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