[1]高沪,李熙鸿.糖皮质激素对脓毒性休克的疗效及预后Meta分析[J].第三军医大学学报,2018,40(07):636-642.
 GAO Hu,LI Xihong.Efficacy and prognosis of glucocorticoid therapy for septic shock: a meta analysis[J].J Third Mil Med Univ,2018,40(07):636-642.
点击复制

糖皮质激素对脓毒性休克的疗效及预后Meta分析(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第07期
页码:
636-642
栏目:
公共卫生与预防医学
出版日期:
2018-04-15

文章信息/Info

Title:
Efficacy and prognosis of glucocorticoid therapy for septic shock: a meta analysis
作者:
高沪李熙鸿
四川大学华西第二医院急诊科,出生缺陷与相关妇儿疾病教育部重点实验室
Author(s):
GAO Hu LI Xihong

Department of Emergency, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China

关键词:
糖皮质激素氢化可的松脓毒性休克Meta分析
Keywords:
glucocorticoids hydrocortisone septic shock meta analysis 
分类号:
R181.23; R631.4; R977.11
文献标志码:
A
摘要:

目的    评价糖皮质激素在脓毒性休克治疗中的效果及对预后的影响。方法    计算机检索Web of Science、PubMed、Embase、Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库,收集有关糖皮质激素治疗脓毒性休克的临床研究,使用Jadad评分对纳入文献的质量进行评价,采用RevMan 5.3软件进行Meta分析。结果    纳入7篇文献,共1 220例患者,Meta分析结果显示:糖皮质激素治疗组与对照组28 d病死率差异无统计学意义(RR=1.09,95%CI为0.85~1.39,P=0.51),糖皮质激素治疗组高血糖并发症(RR=0.59, 95%CI为0.41~0.83, P=0.003)、出血并发症(RR=0.64,95%CI为0.44~0.95,P=0.03)显著高于对照组,但两组二重感染并发症差异无统计学意义(RR=0.88, 95%CI为0.67~1.15,P=0.29)。结论    采用糖皮质激素治疗不能降低脓毒性休克患者的病死率,可增加患者高血糖及出血并发症的发生率,但未增加二重感染的发生风险。

Abstract:

Objective     To evaluate the efficacy and prognosis of glucocorticoid therapy in septic shock.  Methods     The databases including Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP database and Chinese Biomedical Database were searched for clinical trials concerning glucocorticoid therapy for septic shock. Jadad scale was used for methodological quality assessment of the included literatures. Software Revman 5.3 was used for meta analysis. Results     Seven literatures containing a total of 1 220 cases were included for further analysis. The analysis showed that there was no statistical difference in 28day mortality between the glucocorticoid therapy and control groups (RR=1.09, 95%CI: 0.85~1.39, P=0.51). But the incidence rates of hyperglycemia (RR=0.59, 95%CI: 0.41~0.83, P=0.003) and bleeding (RR=0.64, 95%CI: 0.44~0.95, P=0.03) were obviously higher in the former than the latter group. However, no statistical difference was seen in superinfection between the 2 groups (RR=0.88, 95%CI: 0.67~1.15, P=0.29). Conclusion     Glucocorticoid therapy does not reduce the 28-day mortality in septic shock patients, but increases the incidences of hyperglycemia and hemorrhage, though it having no significant difference in the incidence of superinfection when compared with conventional treatment.

参考文献/References:

[1]VINCENT J L, SAKR Y, SPRUNG C L, et al. Sepsis in European intensive care units: Results of the SOAP study[J]. Crit Care Med, 2006, 34(2): 344-353. DOI: 10.1097/01.ccm.0000194725.48928.3a.
[2]DELLINGER R P, LEVY M M, RHODES A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012[J]. Crit Care Med, 2013, 41(2): 580-637. DOI: 10.1097/CCM.0b013e318 27e83af.
[3]DELLINGER R P, LEVY M M, CARLET J M, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Crit Care Med, 2008, 36(1): 296-327. DOI: 10.1097/01.ccm.0000298 158.12101.41.
[4]BATZOFIN B M, SPRUNG C L, WEISS Y G. The use of steroids in the treatment of severe sepsis and septic shock[J]. Best Pract Res Clin Endocrinol Metab, 2011, 25(5): 735-743. DOI: 10.1016/j.beem.2011.05.006.
[5]梁欢, 王军, 苗常青, 等. 氢化可的松琥珀酸钠治疗脓毒性休克的临床疗效观察[J]. 中国中西医结合急救杂志, 2014(2): 88-90. DOI: 10.3969/j.issn.1008-9691.2014.02.003.
LIANG H, WANG J, MIAO C Q, et al. Hydrocortisone sodium succinate in the treatment of septic shock clinical efficacy [J]. Chin J TCM WM Crit Care, 2014(2): 88-90. DOI:10.3969/j.issn.10089691.2014.02.003.
[6]熊滨, 林勇军, 吕立文, 等. 小剂量氢化可的松在脓毒性休克治疗中的应用[J]. 中国误诊学杂志, 2011, 11(4): 766-768. DOI: 10096647(2011)04-0766-03.
XIONG B, LIN Y J, LV L W, et al. Small doses of hydrocortisone in the treatment of septic shock [J]. Chin J Misdiagn, 2011,11(4): 766-768. DOI: 1009-6647(2011)04-0766-03.
[7]VOLBEDA M, WETTERSLEV J, GLUUD C, et al. Glucocorticosteroids for sepsis: systematic review with metaanalysis and trial sequential analysis[J]. Intensive Care Med, 2015, 41(7): 1220-1234. DOI:10.1007/s00134-015-3899-6.
[8]ANNANE D, S BILLE V, CHARPENTIER C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock[J]. JAMA, 2002, 288(7): 862-871. DOI: 10.1001/jama.288.7.862.
[9]SPRUNG C L, ANNANE D, KEH D, et al. Hydrocortisone therapy for patients with septic shock[J]. N Engl J Med, 2008, 358(2): 111-124. DOI: 10.1056/NEJMoa071366.
[10]VALOOR H T, SINGHI S, JAYASHREE M. Lowdose hydrocortisone in pediatric septic shock: an exploratory study in a third world setting[J]. Pediatr Crit Care Med, 2009, 10(1): 121-125. DOI: 10.1097/PCC.0b013e3181936ab3.
[11]ARABI Y M, ALJUMAH A, DABBAGH O, et al. Lowdose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial[J]. CMAJ, 2010, 182(18): 1971-1977. DOI: 10.1503/cmaj.090707.
[12]吴军, 刘泽, 张源源, 等. 小剂量糖皮质激素在老年脓毒性休克中的应用[J]. 中华急诊医学杂志, 2011, 20(11): 1187-1189. DOI: 10. 3760/cma. j.issn.1671-0282.2011.11.020.
WU J, LIU Z, ZHANG Y Y, et al. Small doses of glucocorticoid in elderly septic shock [J]. Chin J Emerg Med, 2011, 20(11): 1187-1189. DOI: 10.3760/cma.j.issn.1671-0282.2011.11.020.
[13]李刚, 顾承东, 张素巧,等. 糖皮质激素对重症社区获得性肺炎合并脓毒性休克患者的治疗价值[J]. 中华危重病急救医学, 2016, 28(9): 780-784. DOI: 10.3760/cma.j.issn.2095-4352.2016.09.003.
LI G, GU C D, ZHANG S Q, et al. Glucocorticoid on severe communityacquired pneumonia in patients with septic shock treatment [J]. Chin Crit Care Med, 2016,28(9):780-784. DOI: 10.3760/cma.j.issn.2095-4352.2016.09.003.
[14]MENON K, MCNALLY D, O’HEARN K, et al. A randomized controlled trial of corticosteroids in pediatric septic shock: a pilot feasibility study[J]. Pediatr Crit Care Med, 2017, 18(6): 505-512. DOI: 10.1097/pcc.0000000000001121.
[15]濮娜, 吴莹, 张彩萍. 氢化可的松不同治疗方案对脓毒性休克患者的影响[J]. 医学研究杂志, 2017, 46(1): 164-166. DOI: 10.11969/j.issn.1673-548X.2017.01.043.
PU N, WU Y, ZHANG C P. Hydrocortisone different treatment of patients with septic shock [J]. J Med Res, 2017, 46(1): 164-166. DOI: 10.11969/j.issn.1673548X. 2017.01.043.
[16]陈志, 杨春丽, 贺慧为, 等. 不同方法补充小剂量糖皮质激素对顽固性脓毒性休克患者影响的比较研究[J]. 中华危重病急救医学, 2015, 27(6): 443-447. DOI: 10.3760/cma.j.issn.20954352.2015.06.006.
CHEN Z, YANG C R, HE H W, et al. Different methods of small doses of glucocorticoid on refractory septic shock in patients with comparative study [J]. Chin Crit Care Med, 2015,27(6):443-447. DOI: 10.3760/cma.j.issn.2095-4352.2015.06.006.
[17]王秋义, 王庆树. 氢化可的松琥珀酸钠给药方式差异对重症脓毒血症继发休克患者生命体征、动态血糖指标及死亡率的影响[J]. 中国现代医学杂志, 2017, 27(13): 82-85. DOI: 10.3969/j.issn.10058982.2017.13.017.
WANG Q Y, WANG Q S. Hydrocortisone sodium succinate administration differences in patients with severe sepsis secondary shock vital signs, dynamic blood glucose and mortality [J]. Chin J Mod Med, 2017, 27(13): 82-85. DOI:10.3969/j.issn.10058982.2017.13.017.
[18]RHODES A, EVANS L E, ALHAZZANI W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Crit Care Med, 2017, 45(3): 486-552. DOI:10.1007/s00134-017-4683-6.
[19]姜相明, 游道峰, 赵红敏, 等. 早期小剂量糖皮质激素对脓毒症休克患者血流动力学及预后的影响[J]. 重庆医学, 2017, 46(7): 901-904. DOI:10.3969/j.issn.1671 -8348.2017.07.012.
JIANG X M, YOU D F, ZHAO H M, et al. Early lowdose glucocorticoid on hemodynamics and prognosis in patients with septic shock [J]. Chongqing Med, 2017, 46(7): 901-904. DOI:10.3969/j.issn.1671 8348. 2017.07.012.
[20]VAN DEN BERGHE  G, WOUTERS P, WEEKERS F, et al. Intensive insulin therapy in critically ill patients[J]. N Engl J Med, 2001, 345(19): 1359-1367. DOI: 10.1056/NEJMoa011300.
[21]STEVENSON E K, RUBENSTEIN A R, RADIN G T, et al. Two decades of mortality trends among patients with severe sepsis: a comparative metaanalysis[J]. Crit Care Med, 2014, 42(3): 625-631. DOI: 10.1097/CCM.0000000 000000026.
[22]ANNANE D, BELLISSANT E, SEBILLE V, et al. Impaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserve[J]. Br J Clin Pharmacol, 1998, 46(6): 589-597. DOI: 10.1046/j.13652125.1998.00833.x.
[23]ANNANE D, BELLISSANT E, BOLLAERT P E, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review[J]. JAMA, 2009, 301(22): 2362-2375. DOI: 10.1001/jama.2009.815.
[24]李志华,刘宣,葛勤敏,等.糖皮质激素在脓毒症治疗中的研究进展[J].现代生物医学进展,2015,21(15),4191-4193,4197. DOI:10.13241/j.cnki.pmb.2015.21.053.
LI Z H,LIU X,GE Q M,et al. The Research Progress of Glucocorticoids in the Treatment of Sepsis[J]. Prog Mod Biomed, 2015,21(15):4191-4193,4197. DOI:10.13241/j.cnki.pmb.2015.21.053.
[25]刘辉,姚咏明.皮质醇激素治疗与脓毒症:半个世纪的争论[J].解放军医学杂志,2015,40(2):92-96.DOI:10.11855/j.issn.05777402.2015.02.02.
LIU H,YAO Y M.Corticosteroid therapy in sepsis:A controversy over half a century[J]. Med J Chin PLA, 2015,40(2):92-96.DOI:10.11855/j.issn.0577-7402.2015.02.02.

相似文献/References:

[1]殷作明,胡德耀,李素芝,等.高原高寒战时环境肢体火器伤后应激反应的特点[J].第三军医大学学报,2005,27(07):581.

更新日期/Last Update: 2018-04-11