乌司他丁联合血必净治疗脓毒症临床疗效的系统评价

Clinical effectiveness of ulinastation combined with Xuebijing for treating sepsis：a systematic review

摘要:

目的：系统评价乌司他丁联合血必净治疗脓毒症患者的临床疗效。方法：计算机检索 Cochrane library、PubMed、中国生物医学文献数据库、中国知网、中文科技期刊全文数据库和万方数字化期刊全文数据库，查找有关乌司他丁联合血必净治疗脓毒症患者临床疗效的随机对照试验，并追索纳入文献的参考文献，由2名评价者独立选择实验、提取资料和评估方法学质量，采用 RevMan 5.2 软件进行 Meta 分析。结果：共纳入 15 项随机对照实验研究，共计 1222 例受试者（实验组 509 例，对照组 713 例）。Meta分析结果提示：与单用乌司他丁或血必净或仅使用常规方案治疗脓毒症病人相比，乌司他丁联用血必净能够明显减少患者病死率（RR=0.45，95%CI=0.35～0.59），降低患者 7d的急性生理功能和慢性健康状况评分（acute physiology and chronic health evaluation，APACHEⅡ）（MD=-4.91，95%CI=-6.83～-2.98），缩短机械通气时间（MD=-7.33，95%CI=-10.16～-4.51）以及ICU住院时间（MD=-8.63，95%CI=-11.50～-5.76），且无明显不良反应发生。结论：乌司他丁与血必净联用优于单用二者之一或仅使用常规治疗方案，为脓毒症的治疗提供了新的治疗选择。

Abstract:

Objective：To evaluate the clinical effectiveness of ulinastation combined with Xuebijing for treating sepsis. Method：The database such as Cochrane library，PubMed，CBM，CNKI，VIP and WanFang Data were searched to collect randomized controlled trials（RCTs），and the relevant references of included studies were also retrieved. Studies were screened，data were extracted，and the methodological quality was assessed by two reviewers independently. Meta-analysis was conducted by using RevMan 5.2 software. Results：A total of 15 studies involving 1 222 participants（experimental group：509，control group：713） were included. The results showed that compared with the group of routine therapies and group of single administration of either Ulinastatin or Xuebijing，experi－mental group of Ulinastatin combined with Xuebijing was superior in the following aspects with significant differences：morality：RR=0.45，95%CI=0.35 to 0.59，7d APACHEⅡ：MD=-4.91，95%CI=-6.83 to -2.98；duration of mechanical ventilation：MD=-7.33，95%CI=-10.16 to -4.51，the average length of ICU stay：MD=-8.63，95%CI=-11.50 to -5.76. Conclusion：According to the domestic evidence，ulinastatin combined with Xuebijing for treating sepsis is superior to both the routine therapies and the single administration of either Ulinastatin or Xuebijing. It provides a new and prospective therapeutic method for sepsis. However，this con－clusion has to be further verified by large scale and double blinded RCTs.