荟萃分析:类固醇激素剂量对脓毒症患者存活率和休克的影响

作     者：Minneci P.C. Deans K.J. Banks S.M. 任延平 

作者机构：Critical Care Med icine Department National Institutes of Health Building 10 10 Center Drive B ethesda MD 20892 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第1期

页      面：1-2页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：脓毒症 患者存活率 类固醇激素 荟萃分析 加压药 资料提取 糖皮质激素 试验结果 随机对照试验 肾上腺功能 

摘      要：Background: Previous meta analyses demonstrated that high dose glucoc orticoi ds were not beneficial in ***, lower dose glucocorticoids have been studied. Purpose: To compare recent trials of glucocorticoids for sepsis with p revious glucocorticoid trials. Data Sources: Systematic MEDLINE search for studi es published between 1988 and 2003. Study Selection: Randomized,controlled trial s of sepsis that examined the effects of glucocorticoids on survival or vasopres sor requirements. Data Extraction: Two investigators independently collected dat a on patient and study characteristics, treatment interventions, and outcomes. D ata Synthesis: The 5 included trials revealed a consistent and beneficial effect of glucocorticoids on survival (12=0%; relative benefit, 1.23, ; P=0.036) and shock reversal (12=0%; relative benefit, 1.71 ; P; P=0 .008). In comparison with the earlier trials, the more recent trials administere d steroids later after patients met enrollment criteria (median, 23 hours vs. 2 hours; P=0.02), for longer courses (6 days vs. 1 day; P=0.01), and in lower to tal dosages (hydrocort isone equivalents,1209 mg vs. 23 975 mg; P=0.01) to patie nts with higher control group mortality rates (mean, 57%vs. 34%; P=0.06) who w ere more likely to be vasopressor dependent (100%vs. 65%; P=0.03). The relati onship between steroid dose and survival was linear, characterized by benefit at low doses and increasing harm at higher doses (P=0.02). Limitations: We could n ot analyze time related improvements in medical care and potential bias seconda ry to nonreporting of negative study results. Conclusions: Although short course s of high dose glucocorticoids decreased survival during sepsis, a 5-t