Yu Y W, Sun T W, Wan Y D, Liu Z Q, Kan Q C
Department of Integrated Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2016 Feb 23;96(7):570-4. doi: 10.3760/cma.j.issn.0376-2491.2016.07.017.
To evaluate the effect of β-blockers in patients with septic shock.
PubMed, EMBASE, Cochrane central registration of controlled trials, CNKI and Wanfang Data were searched to identify relevant studies from inception to October 2015.Statistical analysis was performed using STATA 12.0.The random effects model was used due to wide clinical variability across the trials.
After application of the inclusion criteria, 7 trials with 392 patients were included, involving 3 randomized controlled trials (RCT) and 4 quasi-experiments.The results of the meta-analysis for the quasi-experiments showed that compared with baseline, heart rates (standardized mean difference (SMD)=-2.51, 95%CI: -4.32--0.70, P=0.007) and lactate levels (SMD=-0.34, 95%CI: -0.67--0.02, P=0.039) significantly decreased, while no significant differences were seen for mean arterial pressure (SMD=0.01, 95%CI: -0.42-0.44, P=0.969), cardiac index (SMD=-0.35, 95%CI: -1.15-0.44, P=0.385) or norepinephrine requirements (SMD=-0.06, 95%CI: -0.38-0.27, P=0.726) after 24-hour therapy. Among randomized controlled trials, β-blockers, compared with standard care, was associated with reductions in heart rates (P<0.001) , 28-day mortality (RR=0.60, 95%CI: 0.48-0.75, P<0.001) and troponin I levels (P<0.001). While no differences were found between the two groups in other hemodynamic and cardiac function variables, such as mean arterial pressure, cardiac index or stroke volume index (P>0.05).
The currently available evidence indicates that the use of β-blockers is associated with a significant decrease in heart rate, troponin I levels and 28-day mortality in patients with septic shock, while mean arterial pressure, cardiac index and stroke volume index might remain unchanged.Large scale, muti-center RCTs need to be carried out to confirm the effects of β-blockers in patients with septic shock.
评估β受体阻滞剂对感染性休克患者的疗效。
检索PubMed、EMBASE、Cochrane对照试验中心注册库、中国知网和万方数据，以识别从研究起始至2015年10月的相关研究。使用STATA 12.0进行统计分析。由于各试验间临床变异性较大，故采用随机效应模型。
应用纳入标准后，纳入了7项试验共392例患者，其中包括3项随机对照试验（RCT）和4项准实验。准实验的荟萃分析结果显示，与基线相比，心率（标准化均数差（SMD）=-2.51，95%可信区间：-4.32--0.70，P=0.007）和乳酸水平（SMD=-0.34，95%可信区间：-0.67--0.02，P=0.039）显著降低，而24小时治疗后平均动脉压（SMD=0.01，95%可信区间：-0.42-0.44，P=0.969）、心脏指数（SMD=-0.35，95%可信区间：-1.15-0.44，P=0.385）或去甲肾上腺素需求量（SMD=-0.06，95%可信区间：-0.38-0.27，P=0.726）无显著差异。在随机对照试验中，与标准治疗相比，β受体阻滞剂可降低心率（P<0.001）、28天死亡率（RR=0.60，95%可信区间：0.48-0.75，P<0.001）和肌钙蛋白I水平（P<0.001）。而两组在其他血流动力学和心脏功能变量上无差异，如平均动脉压、心脏指数或每搏量指数（P>0.05）。
现有证据表明，β受体阻滞剂的使用可使感染性休克患者的心率、肌钙蛋白I水平和28天死亡率显著降低，而平均动脉压、心脏指数和每搏量指数可能保持不变。需要开展大规模、多中心随机对照试验以证实β受体阻滞剂对感染性休克患者的疗效。
