超短效β受体阻滞剂对初始复苏后持续性心动过速的脓毒症患者死亡率的影响：一项随机对照试验的系统评价和荟萃分析。
Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
机构信息
Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
出版信息
Chest. 2021 Jun;159(6):2289-2300. doi: 10.1016/j.chest.2021.01.009. Epub 2021 Jan 9.
BACKGROUND
Historically, β-blockers have been considered to be relatively contraindicated for septic shock because they may cause cardiac suppression. On the other hand, there is an increasing interest in the use of β-blockers for treating patients with sepsis with persistent tachycardia despite initial resuscitation.
RESEARCH QUESTION
Do ultrashort-acting β-blockers such as esmolol and landiolol improve mortality in patients with sepsis with persistent tachycardia despite initial resuscitation?
STUDY DESIGN AND METHODS
This was a systematic review and meta-analysis. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with esmolol or landiolol. We updated our search on April 20, 2020. Two independent reviewers assessed whether titles and abstracts met the following eligibility criteria: (1) RCT, (2) patients with sepsis and septic shock ≥ 18 years of age, and (3) treatment with either esmolol/landiolol or placebo/no interventions. Two authors independently extracted selected patient and study characteristics and outcomes. The results of all analyses are presented using random effect models.
RESULTS
Seven RCTs with a pooled sample size of 613 patients were included. Of these, six RCTs with 572 patients reported 28-day mortality. Esmolol or landiolol use in patients with sepsis and septic shock was significantly associated with lower 28-day mortality (risk ratio, 0.68; 95% CI, 0.54-0.85; P < .001). Unimportant heterogeneity was observed (I = 31%). The absolute risk reduction and number of patients to be treated to prevent one death were 18.2% and 5.5, respectively.
INTERPRETATION
The use of ultrashort-acting β-blockers such as esmolol and landiolol in patients with sepsis with persistent tachycardia despite initial resuscitation was associated with significantly lower 28-day mortality.
TRIAL REGISTRY
UMIN Clinical Trials Registry; No.: UMIN000040174; URL: https://www.umin.ac.jp/ctr/index.htm.
背景
从历史上看，β 受体阻滞剂由于可能导致心脏抑制，因此被认为在感染性休克时相对禁忌。另一方面，越来越多的人对使用β受体阻滞剂治疗感染性休克伴初始复苏后持续心动过速的患者感兴趣。
研究问题
超短效β受体阻滞剂（如艾司洛尔和拉贝洛尔）是否能降低初始复苏后持续心动过速的感染性休克患者的死亡率？
研究设计和方法
这是一项系统评价和荟萃分析。我们检索了 MEDLINE、Cochrane 对照试验中心注册库和 Embase，以查找比较艾司洛尔或拉贝洛尔治疗的感染性和感染性休克患者死亡率的随机对照试验（RCT）。我们于 2020 年 4 月 20 日更新了检索。两名独立的审查员评估标题和摘要是否符合以下纳入标准：（1）RCT；（2）年龄≥18 岁的感染性和感染性休克患者；（3）接受艾司洛尔/拉贝洛尔或安慰剂/无干预治疗。两名作者独立提取了选定的患者和研究特征及结局。所有分析结果均采用随机效应模型呈现。
结果
纳入了 7 项共纳入 613 例患者的 RCT。其中，6 项 RCT 共纳入 572 例患者报告了 28 天死亡率。在感染性和感染性休克患者中使用艾司洛尔或拉贝洛尔与 28 天死亡率降低显著相关（风险比，0.68；95%置信区间，0.54-0.85；P<.001）。观察到低异质性（I=31%）。绝对风险降低和预防 1 例死亡所需的患者数分别为 18.2%和 5.5。
解释
在初始复苏后持续心动过速的感染性休克患者中使用超短效β受体阻滞剂（如艾司洛尔和拉贝洛尔）与 28 天死亡率显著降低相关。
试验注册
UMIN 临床试验注册；编号：UMIN000040174；网址：https://www.umin.ac.jp/ctr/index.htm。
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