去甲肾上腺素与多巴胺治疗心源性休克安全性的Meta分析

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摘要目的：系统评价去甲肾上腺素、多巴胺治疗心源性休克（CS）的安全性。方法：检索美国国立医学图书馆（PubMed）、荷兰医学文摘（EMbase）、Cochrane library、中国知网（CNKI）、万方数据库、维普数据库中关于去甲肾上腺素、多巴胺治疗CS的临床研究。根据纳入、排除标准，两名研究人员独立进行筛选文献、提取文献资料及评估方法学质量，采用Review Manager 5.3软件进行荟萃分析（Meta分析）。结果：最终纳入7项临床研究共381例CS患者。Meta分析显示：应用去甲肾上腺素治疗CS，其28 d病死率是应用多巴胺者的0.54倍（RR=0.54，95%CI为0.37～0.80，P=0.002），其心律失常发生率是应用多巴胺者的0.27倍（RR= 0.27，95%CI为0.16～0.48，P＜0.001）。结论：去甲肾上腺素治疗CS较多巴胺有更好的安全性。

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关键词 ：去甲肾上腺素, 多巴胺, 心源性休克, Meta分析

Abstract：Objective: To systematically evaluate the safety of norepinephrine versus dopamine for the treatment of cardiogenic shock. Methods: Clinical trials of norepinephrine versus dopamine in cardiogenic shock were selected from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data.Study selection, assessment of methodological quality and data extraction were undertaken by two investigators separately, according to the inclusion and exclusion criteria. Meta analysis was performed using Review Manager 5.3 software. Results: A total of seven clinical trials with 381 patients were included. The results of this meta-analysis showed that norepinephrine for the treatment of cardiogenic shock reduced 28-day mortality by 0.54 times, compared to dopamine (RR=0.54, 95%CI: 0.37～0.80, P=0.002). The incidence rate of arrhythmia in norepinephrine group was 0.27 fold than that in dopamine group (RR=0.27, 95%CI: 0.16～0.48, P<0.001). Conclusion: Norepinephrine is safe in the treatment of patients with cardiogenic shock, compared to dopamine.

Key words： norepinephrine dopamine cardiogenic shock meta-analysis

收稿日期: 2017-03-16

通讯作者: 林乐清，主任医师，副教授，硕士生导师，Email：happylin67@126.com

作者简介: 金光勇（1992-），男，浙江义乌人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I10/752

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