血必净联用乌司他丁治疗重症脓毒症有效性的系统评价

Systematic Review of Clinical Efficacy of Xuebijing Combined with Ulinastatin in Treating Patients with Severe Sepsis

摘要:

目的: 系统评价血必净联用乌司他丁治疗重症脓毒症的有效性.方法:计算机检索1990—2013年在美国医学文摘数据库(Medline)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库维普(VIP)和万方数据库,公开发表的血必净联用乌司他丁治疗重症脓毒症的随机对照研究(RCT),提取资料后采用Rev Man 5.2统计学软件进行Meta分析.结果:共纳入8篇RCT,合计735名患者,Jada评分,2篇为3分,2篇为2分, 4篇为1分.Meta分析结果显示,血必净联用乌司他丁分别与单用血必净、单用乌司他丁比较机械通气时间分别为[MD=-2.10,95%CI(-2.88,-1.31),P<0.05],[MD=-3.92,95%CI(-4.59,-3.25),P<0.05];ICU住院时间分别为[MD=-2.07,95%CI(-2.98,-1.17),P<0.05],[MD=-3.76,95%CI(-4.57,-2.96),P<0.05];APACHE-Ⅱ评分分别为[MD=-2.78,95%CI(-4.85,-0.71),P<0.05],[MD=-4.19,95%CI(-5.64,-2.75),P<0.05];降钙素原(PCT)分别为[MD=-0.44,95%CI(-0.54,-0.33),P<0.05],[MD=-0.61,95%CI(-0.67,-0.55),P<0.05];肿瘤坏死因子-α (TNF-α)分别为[MD=-1.38,95%CI(-3.02,-0.25),P<0.05],[MD=-5.91,95%CI(-11.02,-00.80),P<0.05];白细胞介素-6(IL-6) 分别为[MD=-32.96,95%CI(-48.26,-17.66),P<0.05],[MD=-60.42,95%CI(-109.19,-11.65),P<0.05];内毒素(LPS)分别为[MD=-6.38,95%CI(-9.18,-3.58),P<0.05],[MD=-11.08,95%CI(-14.42,-7.75),P<0.05].结论:血必净联用乌司他丁能明显缩短重症脓毒症的机械通气时间、ICU住院时间和APACHE-Ⅱ评分,PCT,TNF-α,IL-6,LPS等炎性指标显著降低,但本研究纳入的研究数量偏少,且方法学上存在缺陷,证据强度不高,因此血必净联用乌司他丁治疗重症脓毒症的有效性仍需深入研究.

Abstract:

Objective:To evaluate the clinical efficacy of Xuebijing combined with ulinastatin in the treatment of severe sepsis patients. Method:The medical literatures (1990 to 2013) were searched from fllowing data sources:Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure VIP and Wanfang citation database online version, and randomized controlled trial about Xuebijing combined with ulinastatin in severe sepsis patients were collected. Meta-analysis of included trials was performed using Rev Man 5.2 software. Result:Total of 8 trials involving 735 patients was included. Of the 2 trials had a Jaded score of 3, 2 trials had a Jaded score of 2, and 4 trials had a Jaded score of 1.Meta-analysis showed that the time of mechanical ventilation in Xuebijing combined with ulinastatin compare with Xuebijing and ulinastatin alone was respectively [MD=-2.10, 95%CI (-2.88, -1.31), P<0.05], [MD=-3.92, 95%CI (-4.59, -3.25), P<0.05];the days of ICU were respectively[MD=-2.07, 95%CI (-2.98, -1.17), P<0.05], [MD=-3.76, 95%CI (-4.57, -2.96), P<0.05];APACHE-Ⅱ was respectively [MD=-2.78, 95%CI(-4.85, -0.71), P<0.05], [MD=-4.19, 95%CI(-5.64, -2.75), P<0.05];procalcitionin (PCT) was respectively [MD=-0.44, 95%CI(-0.54, -0.33), P<0.05], [MD=-0.61, 95%CI (-0.67, -0.55), P<0.05];tumor necrosis factor-α (TNF-α) was respectively [MD=-1.38, 95%CI(-3.02, -0.25), P<0.05], [MD=-5.91, 95%CI(-11.02, -0.80), P<0.05];interleukin 6(IL-6) was respectively [MD=-32.96, 95%CI(-48.26, -17.66), P<0.05], [MD=-60.42, 95%CI (-109.19, -11.65), P<0.05];lipopolysaccharide (LPS) was respectively [MD=-6.38, 95%CI (-9.18, -3.58), P<0.05], [MD=-11.08, 95%CI (-14.42, -7.75), P<0.05]. Conclusion:Using Xuebijing combined with ulinastatin can reduce the time of mechanical ventilation, the days of ICU and APACHE-Ⅱ, and decrease the level of proinflammatory cytokines, such as PCT, TNF-α, IL-6 and LPS. The efficacy of Xuebijing combined with ulinastatin in severe sepsis patients should be determined by more high quality RCTs because of small number and poor methodological quality of included studies in this meta-analysis.