中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
10期
800-804
,共5页
夏海发%孙志鹏%杨依依%尚游%姚尚龙
夏海髮%孫誌鵬%楊依依%尚遊%姚尚龍
하해발%손지붕%양의의%상유%요상룡
西维来司钠%急性肺损伤%急性呼吸窘迫综合征%Meta分析
西維來司鈉%急性肺損傷%急性呼吸窘迫綜閤徵%Meta分析
서유래사납%급성폐손상%급성호흡군박종합정%Meta분석
Sivelestat sodium%Acute lung injury%Acute respiratory distress syndrome%Meta-analysis
目的：系统评价西维来司钠对急性肺损伤/急性呼吸窘迫综合征（ALI /ARDS）患者预后的影响。方法通过计算机检索美国国立医院图书馆PubMed、EBSCO、Springer、Ovid、万方数据库、中国知网CNKI和中国生物医学文献数据库（CBM）等，纳入1985年至2014年12月发表的关于西维来司钠对ALI /ARDS患者预后影响的随机对照试验（RCT）。治疗组持续静脉输注西维来司钠，对照组不用药或者持续静脉输注生理盐水。观察指标为28 d病死率、机械通气时间、重症加强治疗病房（ICU）住院时间、第3天氧合指数。按Cochrane系统评价方法对纳入文献进行资料提取和质量评价，采用RevMan 5.3软件进行Meta分析。用漏斗图评价各研究发表偏倚。结果共纳入5篇RCT研究780例患者，其中西维来司钠组389例，对照组391例。Meta分析结果显示：与对照组相比，西维来司钠并不能降低患者28 d病死率〔优势比（OR）＝0.91，95%可信区间（95%CI）＝0.66～1.26，P＝0.58〕，机械通气时间与ICU住院时间也无明显缩短〔均数差（MD）＝-0.02，95%CI＝-0.29～0.24，P＝0.87；MD＝-9.63，95%CI＝-23.24～4.08，P＝0.17〕，但第3天氧合指数可明显改善（MD＝0.88，95%CI＝0.39～1.36，P＝0.0004）。漏斗图显示各研究的发表偏倚不大。结论西维来司钠不能降低ALI /ARDS患者28 d病死率，也不能缩短机械通气时间和ICU住院时间，但能明显改善患者早期氧合指数。
目的：繫統評價西維來司鈉對急性肺損傷/急性呼吸窘迫綜閤徵（ALI /ARDS）患者預後的影響。方法通過計算機檢索美國國立醫院圖書館PubMed、EBSCO、Springer、Ovid、萬方數據庫、中國知網CNKI和中國生物醫學文獻數據庫（CBM）等，納入1985年至2014年12月髮錶的關于西維來司鈉對ALI /ARDS患者預後影響的隨機對照試驗（RCT）。治療組持續靜脈輸註西維來司鈉，對照組不用藥或者持續靜脈輸註生理鹽水。觀察指標為28 d病死率、機械通氣時間、重癥加彊治療病房（ICU）住院時間、第3天氧閤指數。按Cochrane繫統評價方法對納入文獻進行資料提取和質量評價，採用RevMan 5.3軟件進行Meta分析。用漏鬥圖評價各研究髮錶偏倚。結果共納入5篇RCT研究780例患者，其中西維來司鈉組389例，對照組391例。Meta分析結果顯示：與對照組相比，西維來司鈉併不能降低患者28 d病死率〔優勢比（OR）＝0.91，95%可信區間（95%CI）＝0.66～1.26，P＝0.58〕，機械通氣時間與ICU住院時間也無明顯縮短〔均數差（MD）＝-0.02，95%CI＝-0.29～0.24，P＝0.87；MD＝-9.63，95%CI＝-23.24～4.08，P＝0.17〕，但第3天氧閤指數可明顯改善（MD＝0.88，95%CI＝0.39～1.36，P＝0.0004）。漏鬥圖顯示各研究的髮錶偏倚不大。結論西維來司鈉不能降低ALI /ARDS患者28 d病死率，也不能縮短機械通氣時間和ICU住院時間，但能明顯改善患者早期氧閤指數。
목적：계통평개서유래사납대급성폐손상/급성호흡군박종합정（ALI /ARDS）환자예후적영향。방법통과계산궤검색미국국립의원도서관PubMed、EBSCO、Springer、Ovid、만방수거고、중국지망CNKI화중국생물의학문헌수거고（CBM）등，납입1985년지2014년12월발표적관우서유래사납대ALI /ARDS환자예후영향적수궤대조시험（RCT）。치료조지속정맥수주서유래사납，대조조불용약혹자지속정맥수주생리염수。관찰지표위28 d병사솔、궤계통기시간、중증가강치료병방（ICU）주원시간、제3천양합지수。안Cochrane계통평개방법대납입문헌진행자료제취화질량평개，채용RevMan 5.3연건진행Meta분석。용루두도평개각연구발표편의。결과공납입5편RCT연구780례환자，기중서유래사납조389례，대조조391례。Meta분석결과현시：여대조조상비，서유래사납병불능강저환자28 d병사솔〔우세비（OR）＝0.91，95%가신구간（95%CI）＝0.66～1.26，P＝0.58〕，궤계통기시간여ICU주원시간야무명현축단〔균수차（MD）＝-0.02，95%CI＝-0.29～0.24，P＝0.87；MD＝-9.63，95%CI＝-23.24～4.08，P＝0.17〕，단제3천양합지수가명현개선（MD＝0.88，95%CI＝0.39～1.36，P＝0.0004）。루두도현시각연구적발표편의불대。결론서유래사납불능강저ALI /ARDS환자28 d병사솔，야불능축단궤계통기시간화ICU주원시간，단능명현개선환자조기양합지수。
ObjectiveTo investigate the effect of sivelestat sodium on the prognosis in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Methods Databases including PubMed, EBSCO, Springer, Ovid, Wanfang data, CNKI and China Biology Medicine (CBM) were searched to identify randomized controlled trials (RCTs) regarding sivelestat sodium treatment for ALI/ARDS published from 1985 to December 2014. The patients in treatment group received intravenous infusion of sivelestat sodium, and those in control group received normal saline. The items for analysis were 28-day mortality, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and oxygenation index on day 3. According to the evaluation method of Cochrane system, data extraction and quality assessment from the literature were carried out. Meta-analysis was performed using RevMan 5.3. The publication bias was analyzed with funnel plot.Results Five RCTs with a total of 780 participants were included, with 389 patients in sivelestat sodium group, and 391 in control group. Meta analysis showed: compared with control group, sivelestat sodium could not lower the 28-day mortality [odds ratio (OR) = 0.91, 95% confidence interval (95%CI) =0.66-1.26,P = 0.58], or shorten the duration of mechanical ventilation or length of ICU stay [duration of mechanical ventilation: mean difference (MD) = -0.02, 95%CI = -0.29 to 0.24,P = 0.87; length of ICU stay:MD = -9.63, 95%CI =-23.34 to 4.08,P = 0.17], but it could improve oxygenation index on day 3 (MD = 0.88, 95%CI = 0.39 to 1.36, P = 0.000 4). Heterogeneity was not significant for the main analysis and no publication bias was shown on funnel plot. Conclusion Sivelestat sodium gave rise to a better oxygenation on day 3, but did not change the length of mechanical ventilation and ICU stay, and it did not improve 28-day mortality in ALI and ARDS.
