乌司他丁注射液治疗脓毒症的系统评价

发布时间：2018-03-14 13:25

  本文选题：乌司他丁　切入点：脓毒症　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景脓毒症即指感染所致的全身性炎症反应综合征(SIRS),是严重创伤、烧伤、休克、外科大手术后等危重患者的常见并发症,也是诱发休克、多器官功能不全甚至衰竭的重要原因。严重脓毒症是指脓毒症的基础上伴有器官功能障碍、组织灌注不足(乳酸酸中毒、少尿、意识改变等)以及低血压。脓毒性休克是指严重脓毒症伴经液体复苏仍难以逆转的组织低灌注状态,表现为经过最初的液体复苏后持续低血压或血乳酸浓度升高。脓毒症的发生率和病死率极高,是重症监护病房(ICU)患者的主要死亡原因之一,目前已成为人类十大死因之一。国内一项多中心流行病学调查显示,严重脓毒症在ICU的发病率为8.68%,死亡率高达44.7%,且通常消耗医疗费用极高,给患者身体上、心理上和经济上带来极大负担。在美国,每年有21.5万人死于脓毒症及其后续并发症。ICU中脓毒症总死亡率约30-40%,而在老年或伴有基础疾病的患者中死亡率超过70%。目的评价乌司他丁注射液治疗脓毒症的有效性及安全性。方法应用Revman 5.0软件对乌司他丁注射液治疗脓毒症的随机对照试验(RCT)进行系统评价。计算机检索外文数据库Pubmed(2000-至今),Ovid(2000-至今),Elsevier(2000-至今)及CBM、VIP、CNKI,筛选相关文献。结果共纳入13个RCT试验,共736例患者,乌司他丁组(试验组)370例,对照组366例。Meta分析结果表明,试验组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白细胞(WBC)、C-反应蛋白(CRP)及APACHEⅡ评分等研究与对照组相比均有明显差异性,总体显示有益的变化,个别实验组无差异。没有不良反应的记录。结论乌司他丁治疗脓毒症相对安全,并在改善患者预后、相关指标上具有一定优势,但高质量的研究仍较少,且缺乏大规模临床实验论证,尚无可靠、充分的证据表明乌司他丁治疗脓毒症安全、有效。今后开展相关实验研究,应克服当前研究的局限性,增加纳入例数,改进设计,采用更客观、更受认可、更具有指向性的终点疗效指标。纳入研究的方法学质量评价尚可,但所应用的评价指标对结果的评价有限,有必要进行全面随即双盲临床试验进行论证。
[Abstract]:Background sepsis refers to the systemic inflammatory response syndrome caused by infection. It is a common complication of severe trauma, burn, shock, major surgery and other critical patients, and it is also a kind of induced shock. Severe sepsis refers to severe sepsis with organ dysfunction and insufficient tissue perfusion (lactic acidosis oliguria). Septic shock is a state of tissue hypoperfusion that is difficult to reverse in severe sepsis with fluid resuscitation. After initial fluid resuscitation, continuous hypotension or elevated blood lactate concentration. Sepsis is one of the leading causes of death in ICU patients with high incidence and mortality of sepsis. At present, it has become one of the top ten causes of death in human beings. A multi-center epidemiological survey in China shows that the incidence of severe sepsis in ICU is 8.68, the mortality rate is as high as 44.7, and the cost of medical treatment is usually extremely high. Psychological and economic burdens. In the United States, 215,000 people die each year from sepsis and its complications. The total mortality rate of sepsis in ICU is about 30-400.The mortality rate in elderly patients or patients with underlying diseases is more than 70.ObjectiveTo evaluate the efficacy of ulinastatin injection in the treatment of sepsis. Methods Revman 5.0 software was used to evaluate the randomized controlled trial of ulinastatin injection in the treatment of sepsis. Results A total of 13 RCT trials were conducted. There were 736 patients in Ulinastatin group (370 cases in the trial group and 366 cases in the control group). The results of Meta-analysis showed that there were significant differences between the study group and the control group in the study of tumor necrosis factor- 伪 TNF- 伪, interleukin-6 (IL-6), WBCC-reactive protein (APACHE) and APACHE 鈪，

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