CAJ | 학술논문

目的：评价早期目标导向治疗（EGDT）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1980年1月至2015年5月美国国立医学图书馆PubMed数据库、Cochrane临床试验数据库、荷兰医学文摘EMBASE数据库、万方数据库和中国知网数据库有关文献。纳入标准：研究对象为成人严重脓毒症或脓毒性休克患者；试验设计为随机对照试验（RCT）、半随机对照试验（CCT）、病例对照研究（CCS）、队列研究，且数据资料齐全；研究指标为短期病死率〔院内、重症加强治疗病房（ICU）、28 d〕、远期病死率（60 d、90 d或1年）。采用RevMan 5.2软件进行EGDT治疗对严重脓毒症或脓毒性休克患者病死率影响的Meta分析，并绘制漏斗图评价文献发表偏倚情况。结果最终纳入12篇文献、5528例患者，其中4篇为RCT，3篇为前后对照观察研究，4篇为队列研究，1篇为准实验研究。Meta分析显示，EGDT可降低严重脓毒症或脓毒性休克患者的短期病死率〔相对危险度（RR）＝0.72，95%可信区间（95%CI）＝0.64～0.80，P＝0.00001〕，但对于降低远期病死率无影响（RR＝0.99，95%CI＝0.92～1.06，P＝0.81）。漏斗图显示，12篇文献不存在发表偏倚。EGDT推荐级别为C级。结论 EGDT能降低严重脓毒症或脓毒性休克患者的短期病死率，但对远期病死率无影响，推荐级别为C级。
목적：평개조기목표도향치료（EGDT）대엄중농독증혹농독성휴극환자병사솔적영향。방법계산궤검색1980년1월지2015년5월미국국립의학도서관PubMed수거고、Cochrane림상시험수거고、하란의학문적EMBASE수거고、만방수거고화중국지망수거고유관문헌。납입표준：연구대상위성인엄중농독증혹농독성휴극환자；시험설계위수궤대조시험（RCT）、반수궤대조시험（CCT）、병례대조연구（CCS）、대렬연구，차수거자료제전；연구지표위단기병사솔〔원내、중증가강치료병방（ICU）、28 d〕、원기병사솔（60 d、90 d혹1년）。채용RevMan 5.2연건진행EGDT치료대엄중농독증혹농독성휴극환자병사솔영향적Meta분석，병회제루두도평개문헌발표편의정황。결과최종납입12편문헌、5528례환자，기중4편위RCT，3편위전후대조관찰연구，4편위대렬연구，1편위준실험연구。Meta분석현시，EGDT가강저엄중농독증혹농독성휴극환자적단기병사솔〔상대위험도（RR）＝0.72，95%가신구간（95%CI）＝0.64～0.80，P＝0.00001〕，단대우강저원기병사솔무영향（RR＝0.99，95%CI＝0.92～1.06，P＝0.81）。루두도현시，12편문헌불존재발표편의。EGDT추천급별위C급。결론 EGDT능강저엄중농독증혹농독성휴극환자적단기병사솔，단대원기병사솔무영향，추천급별위C급。
ObjectiveTo investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Methods Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.Results There were 12 studies meeting inclusive criteria including 5 528 patients, 4 RCTs, 3 case-control studies, 4 cohort studies, and 1 quasi-experimental research. It was shown by Meta analysis that EGDT was associated with significant decrease in the short-term mortality [relative risk (RR) = 0.72, 95% confidence interval (95%CI) = 0.64-0.80,P< 0.000 01], but not associated with decrease of long-term mortality (RR = 0.99, 95%CI = 0.92-1.06,P = 0.81). The funnel plot showed that there was no publication bias. EGDT was recommended as grade C.Conclusions EGDT was associated with significant improvement in short-term mortality but not with long-term mortality in patients with severe sepsis or septic shock. Grade C was recommended by our study.