Smyth Michael A, Brace-McDonnell Samantha J, Perkins Gavin D
University of Warwick, Clinical Trials Unit, Coventry, England.
West J Emerg Med. 2016 Jul;17(4):427-37. doi: 10.5811/westjem.2016.5.30172. Epub 2016 Jul 5.
Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients.
We systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation) methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations to report findings.
Nine studies met the eligibility criteria - one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted.
There is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient's passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking.
脓毒症是对感染的一种常见且可能危及生命的反应。国际脓毒症治疗指南提倡尽早开始治疗。目前尚不清楚救护车临床医生在到达医院之前进行的极早期干预是否能改善脓毒症患者的临床结局。
我们系统检索了截至2015年6月的电子数据库MEDLINE、EMBASE、CINAHL、Cochrane图书馆和PubMed。此外，还联系了相关主题专家。我们采用GRADE（推荐分级评估、制定和评价）方法进行综述，并遵循PRISMA（系统评价和Meta分析的首选报告项目）建议报告研究结果。
九项研究符合纳入标准——一项研究为随机对照试验，其余研究本质上为观察性研究。各项研究采用的方法学途径和报告的结局指标存在很大差异。由于这些差异，这些研究并未回答一个独特的研究问题，因此不适合进行Meta分析。我们采用了叙述性的数据综合方法。
关于院前干预对脓毒症结局影响的有力证据很少。现有的证据质量较低，表明院前干预对脓毒症结局的影响有限，除了改善流程结局和加快患者通过急诊护理路径外。目前缺乏表明院前抗生素治疗和液体复苏能改善患者结局的证据。
