目的 评价早期目标导向治疗(EGDT)对脓毒症或脓毒性休克患者的疗效.方法 计算机检索美国国立医学图书馆MEDLINE数据库,Cochrane临床试验数据库、Embase、PubMed、SpringerLink、Elsevier-Science-Direct、OVID-lww-oup等英文数据库及中国生物医学文献数据库、中国期刊全文数据库、重庆维普数据库、中国知网期刊全文库、万方数据库、移动数字图书馆等中文数据库自建库至2017年8月的文献.检索词为:脓毒症、脓毒性休克、液体治疗、早期目标导向治疗、sepsis、severe sepsis、septic shock、early goal-directed therapy.应用Rev-Man5.2软件进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型进行数据合并,计算合并风险比及其95％可信区间并对分析结果进行敏感性分析,采用绘制漏斗图法评估发表偏倚.结果 共纳入21项研究,共计6369例患者,其中行EGDT患者3167例,常规治疗患者3202例.所纳入的文献偏倚以Cochrane协作网的偏倚风险评价工具进行评估.经Meta分析,与常规液体治疗相比,EGDT方案对脓毒症或脓毒性休克患者的住院病死率、28 d病死率、住院时间及机械通气时间的影响差异有统计学意义,结果分别为(RR=0.77,95％CI=0.60～0.99,P=0.04);(RR=0.68,95％CI=0.55～0.86,P<0.05);(MD=-3.24,95％CI=-4.49～-1.99,P<0.05);(MD=-1.09,95％CI=-1.41～-0.77,P<0.05),但对于60 d病死率及90 d病死率并没有显著影响,结果均显示无统计学意义,结果分别为(RR=0.83,95％CI=0.64～1.09,P=0.17);(RR=0.99,95％CI=0.90～1.09,P=0.87).结论 EGDT方案可降低脓毒症或脓毒性休克患者住院病死率、28 d病死率、住院时间及机械通气时间.尚不能证实EGDT可改善脓毒症或脓毒性休克患者的60 d及90 d病死率.%Objective To evaluate the efficacy of early goal-directed therapy (EGDT)in patients with sepsis or septic shock.Methods By searching the English and Chinese literature databases from inception to Au-gust 2017,and setting up the key words with sepsis,severe sepsis,septic shock,fluid therapy,early goal-directed therapy,a meta analysis was conducted with RevMan5 .2 software.According to the results of het-erogeneity test,fixed effect model or random effect model for data merging were selected,consolidated risk ratio and 95％ confidence interval were calculated,and sensitivity of the results was analyzed after u-sing funnel plot method to assess the publication bias.Results A total of 21 studies involving 6369 pa-tients were included,in which 3167 patients were treated with EGDT,and 3202 patients were treated with conventional fluid management.The bias of included literature was assessed using the Cochrane col-laboration bias risk assessment tool.By meta analysis,a significant reduction was observed in hospital mortality,28 days mortality,length of hospital stay and mechanical ventilation time associated with EGDT compared with the conventional fluid therapy.The results were:RR=0.77,95％CI:0.60～0.99, P =0.04;RR=0.68,95％CI:0.55 ～0.86,P <0.05;MD=-3.24,95％CI:-4.49 ～-1.99,P <0.05;MD=-1.09,95％CI:-1.41～-0.77,P<0.05 respectively.However,no differences were found on 60 days mortality and 90 days mortality (RR=0.83,95％CI:0.64～1.09,P=0.17;RR=0.99,95％CI:0.90 ～ 1.09,P =0.87).Conclusion EGDT can reduce the hospital mortality,28 days mortality, length of hospital stay and mechanical ventilation time in patients with sepsis or septic shock.It is not proved that EGDT can improve the mortality of patients with sepsis and septic shock at 60 and 90 days.
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