烧伤后肾上腺素能阻滞的疗效与安全性：一项系统评价与荟萃分析。
The efficacy and safety of adrenergic blockade after burn injury: A systematic review and meta-analysis.
作者信息
Flores Orlando, Stockton Kellie, Roberts Jason A, Muller Michael J, Paratz Jennifer D
机构信息
From the Burns, Trauma & Critical Care Research Centre (O.F., J.A.R., M.J.M., J.D.P.), School of Medicine, The University of Queensland; Centre for Children's Burns and Trauma Research (K.S.), Queensland Children's Medical Research Institute; Department of Intensive Care Medicine (J.A.R., J.D.P.), Pharmacy Department (J.A.R.), and The Professor Stuart Pegg Adult Burn Service (M.J.M.), Royal Brisbane and Women's Hospital; and Rehabilitation Sciences (J.D.P.), Griffith University, Brisbane, Australia.
出版信息
J Trauma Acute Care Surg. 2016 Jan;80(1):146-55. doi: 10.1097/TA.0000000000000887.
BACKGROUND
The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury.
METHODS
The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and an appraisal of risk of bias was performed.
RESULTS
From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria. Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect favoring propranolol use that significantly decreased resting energy expenditure (g = -0.64; 95% CI, -0.8 to -0.5; p < 0.001) and trunk fat (g = -0.3; 95% CI, -0.4 to -0.1; p < 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3-0.6; p < 0.001) and insulin resistance (g = -1.35; 95% CI, -2.0 to -0.6; p < 0.001). Occurrence of adverse events was not significantly different between the treated patients the and controls.
CONCLUSION
Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on adult population with a broader range of outcome measures are warranted.
LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
背景
严重烧伤后的高代谢状态是一个主要问题，可导致多种病理生理变化并产生多种后遗症。肾上腺素能阻滞剂已被广泛用于逆转这些变化并改善烧伤患者的预后，但尚未得到严格评估。本系统评价的目的是研究烧伤后使用肾上腺素能阻滞剂的疗效和安全性。
方法
通过OVID检索MEDLINE数据库、PubMed、EMBASE、CINAHL、Cochrane图书馆和Web of Science数据库，检索时间从数据库建立至2014年12月，检索词包括烧伤和β受体阻滞剂以及适当的同义词。文章仅限于以英文、法文或西班牙文发表的文献。筛选随机对照试验、非随机对照试验和系统评价。经过独立筛选和全文审查，选择了10篇文章，并对偏倚风险进行了评估。
结果
在筛选的182篇文章中，9项随机对照试验和1项非随机对照试验符合纳入标准。进行汇总分析以计算效应量和95%置信区间（CI）。使用普萘洛尔有积极效果，显著降低静息能量消耗（g=-0.64；95%CI，-0.8至-0.5；p<0.001）和躯干脂肪（g=-0.3；95%CI，-0.4至-0.1；p<0.001），并改善外周瘦体重（g=0.45；95%CI，0.3-0.6；p<0.001）和胰岛素抵抗（g=-1.35；95%CI，-2.0至-0.6；p<0.001）。治疗患者与对照组之间不良事件的发生率无显著差异。
结论
有限的证据表明烧伤后使用普萘洛尔有益，且其使用似乎是安全的。然而，有必要对成年人群进行进一步试验，采用更广泛的结局指标。
证据级别
系统评价和荟萃分析，III级。
Zotero 插件