去甲肾上腺素与多巴胺治疗感染性休克的疗效比较：一项荟萃分析

Zhou Fei-hu, Song Qing

Department of Critical Care Medicine, PLA General Hospital, Beijing 100853, China. Corresponding author: Song Qing, Email:

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Aug;25(8):449-54.

OBJECTIVE

To systematically evaluate the effect of norepinephrine and dopamine on patients with septic shock.

METHODS

Randomized controlled trials (RCTs) about treatment of adults with septic shock with norepinephrine and dopamine were selected from PubMed, Embase, the Cochrane Library, CBM and CNKI databases. Meta analysis concerning the effect of norepinephrine and dopamine on hemodynamics and metabolism of patients with septic shock was conducted by using Review Manager 5.0 software. The results were expressed as risk ratio (RR) for dichotomous outcomes or standardized mean difference (SMD) for continuous data with 95% confidence intervals (95%CI).

RESULTS

Eleven trials with 1718 cases were enrolled. Meta analysis showed that compared with dopamine, norepinephrine could decrease the mortality (RR=0.89, 95%CI 0.81-0.98, P=0.02). There were a decreased heart rate (SMD=-2.23, 95%CI -3.76 to -0.71, P=0.004), cardiac index (SMD=-0.71, 95%CI -1.07 to -0.35, P=0.0001) and an increased systemic vascular resistance index (SMD=1.39, 95%CI 0.54-2.23, P=0.001) were found in norepinephrine group compared with dopamine group. However, there were no significant differences on the effect of mean artery pressure (SMD=0.64, 95%CI -1.09-2.38, P=0.47), oxygen delivery (SMD=-0.54, 95%CI -1.50-0.42, P=0.27), oxygen consumption(SMD=-0.49, 95%CI -1.37-0.39, P=0.27) and lactic acid (SMD=-0.24, 95%CI -0.90-0.42, P=0.48) between these two vasopressors.

CONCLUSIONS

Norepinephrine is associated with an improved hemodynamics and decreased mortality compared with dopamine in septic shock patients.

目的

系统评价去甲肾上腺素和多巴胺对感染性休克患者的影响。

方法

从PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库（CBM）和中国知网（CNKI）数据库中筛选关于去甲肾上腺素和多巴胺治疗成人感染性休克的随机对照试验（RCT）。使用RevMan 5.0软件对去甲肾上腺素和多巴胺对感染性休克患者血流动力学和代谢的影响进行Meta分析。结果以二分类结局的风险比（RR）或连续数据的标准化均数差（SMD）表示，并给出95%置信区间（95%CI）。

结果

纳入11项试验，共1718例患者。Meta分析显示，与多巴胺相比，去甲肾上腺素可降低死亡率（RR=0.89，95%CI 0.81-0.98，P=0.02）。与多巴胺组相比，去甲肾上腺素组心率降低（SMD=-2.23，95%CI -3.76至-0.71，P=0.004）、心脏指数降低（SMD=-0.71，95%CI -1.07至-0.35，P=0.0001），全身血管阻力指数升高（SMD=1.39，95%CI 0.54-2.23，P=0.001）。然而，在平均动脉压（SMD=0.64，95%CI -1.09-2.38，P=0.47）、氧输送（SMD=-0.54，95%CI -1.50-0.42，P=0.27）、氧消耗（SMD=-0.49，95%CI -1.37-0.39，P=0.27）和乳酸（SMD=-0.24，95%CI -0.90-0.42，P=0.48）方面，这两种血管活性药物之间无显著差异。