Tan Ruimin, Guo He, Yang Zinan, Yang Huihui, Li Qinghao, Zhu Qiong, Du Quansheng
School of Clinical Medical, North China University of Science and Technology, Tangshan, Hebei, China.
Critical Care Department, Hebei General Hospital, Shijiazhuang, Hebei, China.
Front Pharmacol. 2024 Mar 8;15:1358735. doi: 10.3389/fphar.2024.1358735. eCollection 2024.
We conducted a systematic review to assess the advantages and disadvantages of levosimendan in patients with sepsis compared with placebo, milrinone, and dobutamine and to explore the clinical efficacy of different concentrations of levosimendan. PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang data, VIP, and CBM databases were searched using such keywords as simendan, levosimendan, and sepsis. The search time was from the establishment of the database to July 2023. Two researchers were responsible for literature screening and data collection respectively. After the risk of bias in the included studies was evaluated, network meta-analysis was performed using R software gemtc and rjags package. Thirty-two randomized controlled trials (RCTs) were included in the network meta-analysis. Meta-analysis results showed that while levosimendan significantly improved CI levels at either 0.1 µg/kg/min (mean difference [MD] [95%CrI] = 0.41 [-0.43, 1.4]) or 0.2 µg/kg/min (MD [95%CrI] =0.54 [0.12, 0.99]). Levosimendan, at either 0.075 µg/kg/min (MD [95% CrI] =0.033 [-0.75, 0.82]) or 0.2 µg/kg/min (MD [95% CrI] = -0.014 [-0.26, 0.23]), had no significant advantage in improving Lac levels. Levosimendan, at either 0.1 µg/kg/min (RR [95% CrI] = 0.99 [0.73, 1.3]) or 0.2 µg/kg/min (RR [95% CrI] = 1.0 [0.88, 1.2]), did not have a significant advantage in reducing mortality. The existing evidence suggests that levosimendan can significantly improve CI and lactate levels in patients with sepsis, and levosimendan at 0.1 µg/kg/min might be the optimal dose. Unfortunately, all interventions in this study failed to reduce the 28-day mortality. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441220.
我们进行了一项系统评价，以评估与安慰剂、米力农和多巴酚丁胺相比，左西孟旦在脓毒症患者中的优缺点，并探讨不同浓度左西孟旦的临床疗效。使用“西孟旦”“左西孟旦”和“脓毒症”等关键词检索了PubMed、科学网、考克兰图书馆、Embase、中国知网、万方数据、维普和中国生物医学文献数据库。检索时间为各数据库建库至2023年7月。两名研究人员分别负责文献筛选和数据收集。在评估纳入研究的偏倚风险后，使用R软件gemtc和rjags包进行网络荟萃分析。网络荟萃分析纳入了32项随机对照试验（RCT）。荟萃分析结果显示，左西孟旦在0.1μg/kg/min（平均差[MD][95%可信区间（CrI）]=0.41[-0.43，1.4]）或0.2μg/kg/min（MD[95%CrI]=0.54[0.12，0.99]）时能显著提高心脏指数（CI）水平。左西孟旦在0.075μg/kg/min（MD[95%CrI]=0.033[-0.75，0.82]）或0.2μg/kg/min（MD[95%CrI]=-0.014[-0.26，0.23]）时，在改善血乳酸（Lac）水平方面无显著优势。左西孟旦在0.1μg/kg/min（风险比[RR][95%CrI]=0.99[0.73，1.3]）或0.2μg/kg/min（RR[95%CrI]=1.0[0.88，1.2]）时，在降低死亡率方面无显著优势。现有证据表明，左西孟旦可显著改善脓毒症患者的CI和血乳酸水平，0.1μg/kg/min的左西孟旦可能是最佳剂量。遗憾的是，本研究中的所有干预措施均未能降低28天死亡率。https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441220
