中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
1期
83-88
,共6页
王洁心%胡琼瑶%丁超峰%胡小君
王潔心%鬍瓊瑤%丁超峰%鬍小君
왕길심%호경요%정초봉%호소군
糖皮质激素%急件呼吸窘迫综合征(ARDS)%Meta分析
糖皮質激素%急件呼吸窘迫綜閤徵(ARDS)%Meta分析
당피질격소%급건호흡군박종합정(ARDS)%Meta분석
Glucocorticoids%Acute respiratory distress syndrome%Meta-analysis
目的 评价糖皮质激素对成人急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效.方法 利用计算机检索已公开发表的有关糖皮质激素治疗ARDS的中英文文献,按纳入、排除标准纳入合格文献并进行质量评价,采用Rev Man 5.0软件进行Meta分析.结果 共纳入8项独立研究,含ARDS患者679例(激素组366例,对照组313例),Meta分析结果显示激素组与对照组相比,总病死率、早期治疗患者病死率、小剂量治疗患者病死率、氧合指数(PaO_2/FiO_2)的差异有统计学意义(P<0.05),合并相对危险度(RR)或标准化均数差(SMD)及95%置信区间(CI)依次为0.55(0.34～0.87),0.49(0.28～0.86),0.46(0.24～0.88),2.99(0.63～5.34).而晚期治疗患者病死率、大剂量治疗患者病死率、新发感染率的差异均无统计学意义(P>0.05).结论 早期激素治疗或小剂量激素治疗能够降低ARDS患者的病死率;激素应用后氧合情况有显著改善;激素治疗没有显著增加或减少感染性并发症的发病率.
目的 評價糖皮質激素對成人急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)的療效.方法 利用計算機檢索已公開髮錶的有關糖皮質激素治療ARDS的中英文文獻,按納入、排除標準納入閤格文獻併進行質量評價,採用Rev Man 5.0軟件進行Meta分析.結果 共納入8項獨立研究,含ARDS患者679例(激素組366例,對照組313例),Meta分析結果顯示激素組與對照組相比,總病死率、早期治療患者病死率、小劑量治療患者病死率、氧閤指數(PaO_2/FiO_2)的差異有統計學意義(P<0.05),閤併相對危險度(RR)或標準化均數差(SMD)及95%置信區間(CI)依次為0.55(0.34～0.87),0.49(0.28～0.86),0.46(0.24～0.88),2.99(0.63～5.34).而晚期治療患者病死率、大劑量治療患者病死率、新髮感染率的差異均無統計學意義(P>0.05).結論 早期激素治療或小劑量激素治療能夠降低ARDS患者的病死率;激素應用後氧閤情況有顯著改善;激素治療沒有顯著增加或減少感染性併髮癥的髮病率.
목적 평개당피질격소대성인급성호흡군박종합정(acute respiratory distress syndrome,ARDS)적료효.방법 이용계산궤검색이공개발표적유관당피질격소치료ARDS적중영문문헌,안납입、배제표준납입합격문헌병진행질량평개,채용Rev Man 5.0연건진행Meta분석.결과 공납입8항독립연구,함ARDS환자679례(격소조366례,대조조313례),Meta분석결과현시격소조여대조조상비,총병사솔、조기치료환자병사솔、소제량치료환자병사솔、양합지수(PaO_2/FiO_2)적차이유통계학의의(P<0.05),합병상대위험도(RR)혹표준화균수차(SMD)급95%치신구간(CI)의차위0.55(0.34～0.87),0.49(0.28～0.86),0.46(0.24～0.88),2.99(0.63～5.34).이만기치료환자병사솔、대제량치료환자병사솔、신발감염솔적차이균무통계학의의(P>0.05).결론 조기격소치료혹소제량격소치료능구강저ARDS환자적병사솔;격소응용후양합정황유현저개선;격소치료몰유현저증가혹감소감염성병발증적발병솔.
Objectives To analyze the effect of glucocorticoids on acute respiratory distress syndrome (ARDS) in adult patients. Method English and Chinese literature about the glucocorticoids treatment for ARDS were electronically searched. Meta-analysis was performed by Rev Man 5.0 software after the data of qualified studies were included in consistence with the criteria of inclusion and exclusion. Results Eight studies including 679 cases(steroid group 366, control group 313) met the inclusion criteria. Resuhs of meta-analysis showed that there were significant differences( P <0.05), between the steroid group and the control group, in mortality in all cases, mortality in patients treated at early stage, mortality in patients treated with low dose steroids, and PaO_2/FiO_2;the relative risks(RRs)/standardized mean difference(SMDs) and 95% confidence intervals(CIs) are 0.55(0. 34 ～ 0.87), 0.49(0.28 ～ 0.86), 0.46(0.24 ～ 0.88) and 2.99(0.63 ～ 5.34). There were no significant differences in mortality in patients treated during late stage, mortality in patients treated with high dose steroids and number of nosocomial infections(P > 0.05). Conclusions Low-dose glucocorticoids or routine dose glucocorticoids given during early stage can reduce mortality in patients with ARDS; the oxygenation of patients is significantly improved after steroid therapy; incidence of infectious complications is neither increased nor decreased by steroid therapy.
