Yuan Jiaojiao, Yang Xiaoling, Yuan Qixi, Li Min, Chen Yu, Dong Chenming
Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. Corresponding author: Dong Chenming, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Jan;32(1):56-61. doi: 10.3760/cma.j.cn121430-20191114-00010.
To systematically review the efficacy of ultrasound-guided fluid resuscitation and early goal-directed therapy (EGDT) in patients with septic shock.
Multiple databases including Wanfang, CNKI, SinoMed, VIP, PubMed, Embase, Cochrane Library and Web of Science were searched from initial to August 2019 for randomized controlled trial (RCT) studies about the comparison of ultrasound-guided fluid resuscitation and EGDT on resuscitation effect in patients with septic shock. Language, country and region were unlimited. Data extraction and quality evaluation were carried out by means of independent review and cross check results by two researchers.
Finally, only two English RCT studies were enrolled. In the two RCT studies, the ultrasound groups used inferior vena cava collapse index (VCCI) and ultrasound score to guide fluid resuscitation, which resulted in clinical heterogeneity. Because the results could not be pooled, only systematic review, not meta-analysis, could be done. There were measurement bias and selection bias in the two RCT studies, and the literature quality level was B and C respectively. System review results showed that using ultrasound would reduce 7-day mortality (15.0% vs. 35.0%, P = 0.039) and prescribe less of 24-hour intravenous fluids (mL: 900 vs. 1 850, P < 0.01) for patients with septic shock as compared with EGDT. Ultrasound was easy to assess the reactive capacity and cardiac function of patients with septic shock, so as to decrease the incidence of pulmonary edema, which was significantly lower than EGDT (15.0% vs. 37.5%, P = 0.022). However, there was no statistically significant difference in 28-day mortality, duration of mechanical ventilation or length of intensive care unit (ICU) stay between the two groups.
The ultrasound-guided fluid resuscitation may be useful and practical for septic shock patients within 7 days after admission as compared with EGDT, but it cannot reduce the 28-day mortality, duration of mechanical ventilation or length of ICU stay.
系统评价超声引导下液体复苏及早期目标导向治疗（EGDT）在感染性休克患者中的疗效。
检索万方、知网、中国生物医学文献数据库、维普、PubMed、Embase、Cochrane图书馆及Web of Science等多个数据库，检索时间从建库至2019年8月，查找关于超声引导下液体复苏与EGDT对感染性休克患者复苏效果比较的随机对照试验（RCT）研究。语言、国家和地区不限。由两名研究人员通过独立评审和交叉核对结果的方式进行数据提取和质量评估。
最终仅纳入2篇英文RCT研究。在这2篇RCT研究中，超声组采用下腔静脉塌陷指数（VCCI）及超声评分指导液体复苏，导致临床异质性。因结果无法合并，故仅能进行系统评价，而非Meta分析。2篇RCT研究均存在测量偏倚和选择偏倚，文献质量等级分别为B级和C级。系统评价结果显示，与EGDT相比，超声引导下液体复苏可降低感染性休克患者7天死亡率（15.0%对35.0%，P = 0.039），减少24小时静脉补液量（mL：900对1 850，P < 0.01）。超声易于评估感染性休克患者的反应能力及心功能，从而降低肺水肿发生率，显著低于EGDT（15.0%对37.5%，P = 0.022）。然而，两组在28天死亡率、机械通气时间或重症监护病房（ICU）住院时间方面差异无统计学意义。
与EGDT相比，超声引导下液体复苏对于入院后7天内的感染性休克患者可能有用且实用，但不能降低28天死亡率、机械通气时间或ICU住院时间。
