早期目标导向治疗对严重脓毒症疗效的Meta分析

发布时间：2018-01-13 15:04

本文关键词：早期目标导向治疗对严重脓毒症疗效的Meta分析　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的系统的评价和分析早期目标导向治疗(early goal-directed therapy,EGDT)对严重脓毒症和脓毒性休克的疗效,为临床提供一定的参考。研究方法采用科克兰(Cochrane)系统评价的研究方法对数据进行Meta分析。检索电子数据库,收集相关文献研究。制订详细的纳入和排除标准,对纳入的随机对照试验(randomized controlled trial,RCT)和前瞻性研究进行数据分析,并提取相关数据,对结果进行分析和结论报告。主要分析的结局疗效指标包括:28天病死率、60天病死率、90天病死率、ICU住院时间、机械通气时间。具体方法如下:(1)以“早期目标导向治疗”、“早期集束化治疗”、“脓毒症”、“严重脓毒症”、“脓毒性休克”作为中文检索关键词,“early goal-directed therapy”、“sepsis”、“severe sepsis”、“septic shock”作为英文检索关键词,计算机检索Pubmed、Nature、Science、中国知网数据库、万方数据库、维普数据库、中国生物医学文献数据库及等电子数据库,收集2001年~2015年公开发表的关于EGDT治疗严重脓毒症和脓毒性休克的临床随机对照试验和前瞻性研究。纳入的研究要求试验组采用EGDT,对照组采用常规治疗。(2)观察员通过阅读标题剔除无关文献、重复文献、动物试验等部分文献,进一步通过阅读文献内容剔除回顾性分析研究、同一人群发表的相似文献等,最终通过严格按照纳入标准纳入11篇文献研究并进行数据分析。(3)采用Cochrane协作网提供的Review Manager 5.1.1软件进行Meta分析。计数资料使用相对危险度(odds ratio,OR)及95%CI(confidence interval,可信区间)作为效应评价;连续变量资料使用均数差(mean difference,MD)/标准化均数差(standandardized mean difference,SMD)及95%CI为效应评价。P0.05表示差异有统计学意义。重视各研究间的异质性并对异质性进行计算,若研究结果异质性在可接受范围内,采用固定效应模型;若异质性较大,则采用随机效应模型。对发表偏移进行检测,并绘制漏斗图,同时采用stata 12.0软件通过Begg's法、Egger's法共同检测文章的发表偏移。研究结果共纳入11项研究,其中4篇为国外研究,7篇为国内研究,共纳入病例4687个,其中EGDT组2336例,常规治疗组2351例。具体结果如下。1.28天病死率共6篇研究报道了28天病死率,其中3篇国外研究、3篇国内研究,共3483病例。结果显示:与常规治疗组比较,EGDT可降低严重脓毒症和脓毒性休克患者的28天病死率,差异有统计学意义,[OR=0.69,95%CI(0.49,0.97),P=0.03]。2.60天病死率共3篇研究报道了60天病死率,均为国外研究,共2704病例。结果显示:与常规治疗组比较,EGDT可降低严重脓毒症和脓毒性休克患者的60天病死率,差异有统计学意义,[OR=0.66,95%CI(0.44,0.97),P=0.04]。3.90天病死率共3篇研究报道了90天病死率,均为国外研究,共3648病例。结果显示:EGDT组与常规治疗组的90天病死率差异无统计学意义,[OR=0.98,95%CI(0.84,1.14),P=0.76]。4.ICU住院时间共6篇研究报道了ICU住院时间,其中1篇国外研究、5篇国内研究,共1498病例。结果显示:与常规治疗组比较,EGDT可缩短严重脓毒症和脓毒性休克患者的ICU住院时间,差异有统计学意义,[SMD=-3.21,95%CI(-4.35,-2.08),P0.00001]。5.机械通气时间共5篇研究报道了机械通气时间,其中3篇国外研究、2篇国内研究,共2583病例。结果显示:与常规治疗组比较,EGDT可缩短严重脓毒症和脓毒性休克患者的呼吸支时间,差异有统计学意义,[OR=-0.98,95%CI(-1.28,-0.68),P0.00001]。研究结论 EGDT在降低严重脓毒症和脓毒性休克患者28天病死率、60天病死率、缩短ICU住院时间和缩短机械通气时间方面优于常规治疗,但其并不能改善严重脓毒症和脓毒性休克患者的90天病死率。
[Abstract]:Early goal-directed therapy evaluation system research and analysis (early goal-directed therapy, EGDT) curative effect on the treatment of severe sepsis and septic shock, provide a reference for clinical research. Using the method of Cochran (Cochrane) of logarithmic systematic evaluation method according to Meta analysis. Electronic database search, collection of relevant literature research. Make detailed inclusion and exclusion criteria, randomized controlled trials (randomized controlled, trial, RCT) and prospective study of data analysis, and extract relevant data, analysis and conclusions of the report on results. Analysis of the effect of the main outcome measures include: 28 day mortality rate, the mortality rate of 60 days, the 90 day mortality rate ICU, the hospitalization time, the time of mechanical ventilation. The specific methods are as follows: (1) to "early goal-directed therapy", "bundle" early, "sepsis", "severe sepsis", "Septic shock" as Chinese search keywords, "early goal-directed therapy", "sepsis", "severe sepsis", "septic shock" as English search keywords, computer retrieval Pubmed, Nature, Science, China CNKI database, Wanfang database, VIP database, China biomedical literature databases and other electronic databases, collected in 2001 ~2015 published on the EGDT for the treatment of severe sepsis and septic shock in randomized clinical trials and prospective study. In the study group using EGDT test requirements, control group with conventional treatment. (2) the observer through reading the title excluding independent literature, repeated literature, animal experiments further through some literature. A retrospective study from reading literature, the same people published similar documents, in strict accordance with the standards into the final through the included 11 articles Research and data analysis. (3) provided by the Cochrane collaboration Review Manager 5.1.1 software for Meta analysis. The relative risk of the use of count data (odds ratio, OR) and 95%CI (confidence interval CI) as effect evaluation; continuous variable data using mean difference (mean, difference, MD) / standard mean difference (standandardized mean, difference, SMD and 95%CI) for evaluation of the effect of.P0.05 was statisticallysignificant. Pay attention to the heterogeneity between the studies and the heterogeneity is calculated, if the results of heterogeneity in the acceptable range, using fixed effect model; if the heterogeneity, the random effects model. To detect publication bias, and funnel plot, while Using Stata 12 software through Begg's method, Egger's method to detect the publication bias. The results included 11 studies, including 4 articles for foreign Study 7 for domestic research, 4687 cases were included, 2336 cases in group EGDT, 2351 cases of conventional treatment group. The main results are as follows.1.28 day mortality rate of a total of 6 studies reported mortality rate of 28 days, of which 3 studies, 3 domestic research, a total of 3483 cases. The results showed: the group with conventional treatment, EGDT may reduce the risk of severe sepsis and septic shock were 28 day mortality, the difference was statistically significant (0.49,0.97, [OR=0.69,95%CI) P=0.03].2.60, a total of 3 day mortality studies reported mortality rate of 60 days, are foreign research, a total of 2704 cases. The results show that: compared with the conventional the treatment group, EGDT may reduce the risk of severe sepsis and septic shock were 60 day mortality, the difference was statistically significant (0.44,0.97, [OR=0.66,95%CI) P=0.04].3.90, a total of 3 day mortality studies reported mortality rate of 90 days, are foreign research, a total of 3648 cases. The results showed that: EGDT group and No statistical significance in the conventional treatment group 90 day mortality between [OR=0.98,95%CI (0.84,1.14), P=0.76].4.ICU hospitalization time a total of 6 studies reported ICU hospitalization, 1 of which 5 domestic and foreign research, research, a total of 1498 cases. The results show that: compared with the conventional treatment group, EGDT can shorten the severe sepsis and sepsis toxic shock in the ICU hospitalization time, the difference was statistically significant (-4.35, [SMD=-3.21,95%CI, -2.08), mechanical ventilation time P0.00001].5. a total of 5 studies reported the duration of mechanical ventilation, 3 of which 2 domestic and foreign research, research, a total of 2583 cases. The results show that: compared with the conventional treatment group, EGDT can shorten the time of respiratory support severe sepsis and septic shock patients, the difference was statistically significant ([OR=-0.98,95%CI, -1.28, -0.68, P0.00001].) the research conclusion of EGDT in reducing severe sepsis and septic shock patients with the mortality rate of 28 days, 60 days Case fatality rate shortened ICU hospitalization time and shorter mechanical ventilation time than conventional treatment, but it could not improve the 90 day mortality of patients with severe sepsis and septic shock.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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