CAJ | 학술논문

目的评价早期目标导向治疗（EGDT）能否改善严重脓毒症/脓毒性休克患者的病死率。方法检索美国国立医学图书馆MEDLINE数据库、荷兰医学文摘EMBASE数据库、Cochrane临床试验数据库、万方数据库及中国知网数据库1993年1月至2015年4月的文献。检索词为：脓毒症、严重脓毒症、脓毒性休克、液体复苏、EGDT、sepsis、severe sepsis、septic shock。入选条件：随机对照试验，试验对象为严重脓毒症或脓毒性休克患者，试验终点为人群短期病死率〔院内、重症加强治疗病房（ICU）或28 d〕、远期病死率（60 d或90 d）。采用相对危险度（RR）和95%可信区间（95%CI）作为评价EGDT组和对照组之间病死率差异的指标。采用RevMan 5.2软件进行Meta分析。结果共检索到8篇文献满足入选条件，总计4853例患者。与常规治疗相比较，采用EGDT方案治疗可以明显降低严重脓毒症/脓毒性休克患者短期病死率（RR＝0.74，95%CI＝0.66～0.82， P＜0.00001），但不能降低远期病死率（RR＝0.99，95%CI＝0.92～1.06，P＝0.81）。结论 EGDT方案能降低严重脓毒症/脓毒性休克患者的短期病死率，但对于远期病死率无影响。
목적평개조기목표도향치료（EGDT）능부개선엄중농독증/농독성휴극환자적병사솔。방법검색미국국립의학도서관MEDLINE수거고、하란의학문적EMBASE수거고、Cochrane림상시험수거고、만방수거고급중국지망수거고1993년1월지2015년4월적문헌。검색사위：농독증、엄중농독증、농독성휴극、액체복소、EGDT、sepsis、severe sepsis、septic shock。입선조건：수궤대조시험，시험대상위엄중농독증혹농독성휴극환자，시험종점위인군단기병사솔〔원내、중증가강치료병방（ICU）혹28 d〕、원기병사솔（60 d혹90 d）。채용상대위험도（RR）화95%가신구간（95%CI）작위평개EGDT조화대조조지간병사솔차이적지표。채용RevMan 5.2연건진행Meta분석。결과공검색도8편문헌만족입선조건，총계4853례환자。여상규치료상비교，채용EGDT방안치료가이명현강저엄중농독증/농독성휴극환자단기병사솔（RR＝0.74，95%CI＝0.66～0.82， P＜0.00001），단불능강저원기병사솔（RR＝0.99，95%CI＝0.92～1.06，P＝0.81）。결론 EGDT방안능강저엄중농독증/농독성휴극환자적단기병사솔，단대우원기병사솔무영향。
Objective To investigate whether early goal-directed therapy ( EGDT ) could lower the mortality rate in patients with severe sepsis and septic shock. Methods Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit ( ICU ) or 28-day ] and long-term mortality ( 60-day or 90-day ). Related risk ( RR ) and 95% confidence interval ( 95%CI ) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis. Results There were 8 studies meeting inclusive criteria with a total of 4 853 patients. For patients with severe sepsis and septic shock, compared with the group with routine treatment, EGDT showed a decrease in the short-term mortality ( RR = 0.74, 95%CI=0.66-0.82, P<0.000 01 ), but did not decrease the long-term mortality ( RR=0.99, 95%CI=0.92-1.06, P=0.81 ). Conclusion EGDT strategy may decrease the short-term mortality in patients with severe sepsis and septic shock, but it showed no influence on the long-term mortality.