Department of Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730030, China.
Chin Med J (Engl). 2019 May 20;132(10):1212-1217. doi: 10.1097/CM9.0000000000000197.
Previous studies on whether or not levosimendan improved the prognosis of patients with sepsis and septic shock have been inconsistent. We aimed to provide an updated analysis of the therapeutic value of levosimendan in adult patients with sepsis and septic shock, in order to provide evidence-based medical evidence for its use.
PubMed, Embase, Cochrane Library, Wanfang Data, and CNKI were searched until August 2018 without language restriction. Randomized controlled studies of levosimendan with either inotropic drugs or placebo for the treatment of sepsis or septic shock were enrolled. The primary outcome was mortality, and cardiac index and serum lactate levels were the secondary outcomes.
A total of 20 randomized controlled studies were included in this meta-analysis, including 1467 patients, with 738 patients in the experimental group (levosimendan group) and 729 patients in the control group (other inotropic drugs or placebo). There were no significant differences in mortality between the levosimendan and control groups (fixed-effect relative risk [RR] = 0.90, 95% confidence interval [CI] [0.79, 1.03], P = 0.13). Levosimendan increased the cardiac index (VMD [weighted mean difference] = 0.51, 95% CI [0.06, 0.95], P = 0.02); and serum lactate levels were lower (VMD = -1.04, 95% CI [-1.47, -0.60], P < 0.00001).
Based on current clinical evidence, levosimendan does not reduce mortality in adult critically ill patients with sepsis and septic shock. Physicians should use levosimendan with caution in patients with sepsis and septic shock.
关于左西孟旦是否改善脓毒症和脓毒性休克患者预后的既往研究结果并不一致。我们旨在对左西孟旦治疗成人脓毒症和脓毒性休克的疗效进行更新的分析，为其临床应用提供循证医学证据。
检索PubMed、Embase、Cochrane 图书馆、万方数据和中国知网，检索时限均截至 2018 年 8 月，不限制语言。纳入左西孟旦联合正性肌力药物或安慰剂治疗脓毒症或脓毒性休克的随机对照研究。主要结局为死亡率，次要结局为心指数和血清乳酸水平。
共纳入 20 项随机对照研究，共计 1467 例患者，实验组（左西孟旦组）738 例，对照组（其他正性肌力药物或安慰剂组）729 例。左西孟旦组与对照组死亡率差异无统计学意义（固定效应相对危险度 [RR]＝0.90，95％置信区间 [CI] [0.79, 1.03]，P＝0.13）。左西孟旦组心指数增加（加权均数差 [WMD]＝0.51，95％CI [0.06, 0.95]，P＝0.02），血清乳酸水平降低（WMD＝-1.04，95％CI [-1.47, -0.60]，P＜0.00001）。
基于目前的临床证据，左西孟旦不能降低成人脓毒症和脓毒性休克患者的死亡率。临床医生应谨慎使用左西孟旦治疗脓毒症和脓毒性休克患者。
