本文關(guān)鍵詞：早期目標(biāo)導(dǎo)向治療對(duì)嚴(yán)重膿毒癥療效的Meta分析　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

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【摘要】：研究目的 系統(tǒng)的評(píng)價(jià)和分析早期目標(biāo)導(dǎo)向治療(early goal-directed therapy,EGDT)對(duì)嚴(yán)重膿毒癥和膿毒性休克的療效,為臨床提供一定的參考。研究方法 采用科克蘭(Cochrane)系統(tǒng)評(píng)價(jià)的研究方法對(duì)數(shù)據(jù)進(jìn)行Meta分析。檢索電子數(shù)據(jù)庫(kù),收集相關(guān)文獻(xiàn)研究。制訂詳細(xì)的納入和排除標(biāo)準(zhǔn),對(duì)納入的隨機(jī)對(duì)照試驗(yàn)(randomized controlled trial,RCT)和前瞻性研究進(jìn)行數(shù)據(jù)分析,并提取相關(guān)數(shù)據(jù),對(duì)結(jié)果進(jìn)行分析和結(jié)論報(bào)告。主要分析的結(jié)局療效指標(biāo)包括:28天病死率、60天病死率、90天病死率、ICU住院時(shí)間、機(jī)械通氣時(shí)間。具體方法如下:(1)以“早期目標(biāo)導(dǎo)向治療”、“早期集束化治療”、“膿毒癥”、“嚴(yán)重膿毒癥”、“膿毒性休克”作為中文檢索關(guān)鍵詞,“early goal-directed therapy”、“sepsis”、“severe sepsis”、“septic shock”作為英文檢索關(guān)鍵詞,計(jì)算機(jī)檢索Pubmed、Nature、Science、中國(guó)知網(wǎng)數(shù)據(jù)庫(kù)、萬方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)及等電子數(shù)據(jù)庫(kù),收集2001年~2015年公開發(fā)表的關(guān)于EGDT治療嚴(yán)重膿毒癥和膿毒性休克的臨床隨機(jī)對(duì)照試驗(yàn)和前瞻性研究。納入的研究要求試驗(yàn)組采用EGDT,對(duì)照組采用常規(guī)治療。(2)觀察員通過閱讀標(biāo)題剔除無關(guān)文獻(xiàn)、重復(fù)文獻(xiàn)、動(dòng)物試驗(yàn)等部分文獻(xiàn),進(jìn)一步通過閱讀文獻(xiàn)內(nèi)容剔除回顧性分析研究、同一人群發(fā)表的相似文獻(xiàn)等,最終通過嚴(yán)格按照納入標(biāo)準(zhǔn)納入11篇文獻(xiàn)研究并進(jìn)行數(shù)據(jù)分析。(3)采用Cochrane協(xié)作網(wǎng)提供的Review Manager 5.1.1軟件進(jìn)行Meta分析。計(jì)數(shù)資料使用相對(duì)危險(xiǎn)度(odds ratio,OR)及95%CI(confidence interval,可信區(qū)間)作為效應(yīng)評(píng)價(jià);連續(xù)變量資料使用均數(shù)差(mean difference,MD)/標(biāo)準(zhǔn)化均數(shù)差(standandardized mean difference,SMD)及95%CI為效應(yīng)評(píng)價(jià)。P0.05表示差異有統(tǒng)計(jì)學(xué)意義。重視各研究間的異質(zhì)性并對(duì)異質(zhì)性進(jìn)行計(jì)算,若研究結(jié)果異質(zhì)性在可接受范圍內(nèi),采用固定效應(yīng)模型;若異質(zhì)性較大,則采用隨機(jī)效應(yīng)模型。對(duì)發(fā)表偏移進(jìn)行檢測(cè),并繪制漏斗圖,同時(shí)采用stata 12.0軟件通過Begg's法、Egger's法共同檢測(cè)文章的發(fā)表偏移。研究結(jié)果 共納入11項(xiàng)研究,其中4篇為國(guó)外研究,7篇為國(guó)內(nèi)研究,共納入病例4687個(gè),其中EGDT組2336例,常規(guī)治療組2351例。具體結(jié)果如下。1.28天病死率共6篇研究報(bào)道了28天病死率,其中3篇國(guó)外研究、3篇國(guó)內(nèi)研究,共3483病例。結(jié)果顯示:與常規(guī)治療組比較,EGDT可降低嚴(yán)重膿毒癥和膿毒性休克患者的28天病死率,差異有統(tǒng)計(jì)學(xué)意義,[OR=0.69,95%CI(0.49,0.97),P=0.03]。2.60天病死率共3篇研究報(bào)道了60天病死率,均為國(guó)外研究,共2704病例。結(jié)果顯示:與常規(guī)治療組比較,EGDT可降低嚴(yán)重膿毒癥和膿毒性休克患者的60天病死率,差異有統(tǒng)計(jì)學(xué)意義,[OR=0.66,95%CI(0.44,0.97),P=0.04]。3.90天病死率共3篇研究報(bào)道了90天病死率,均為國(guó)外研究,共3648病例。結(jié)果顯示:EGDT組與常規(guī)治療組的90天病死率差異無統(tǒng)計(jì)學(xué)意義,[OR=0.98,95%CI(0.84,1.14),P=0.76]。4.ICU住院時(shí)間共6篇研究報(bào)道了ICU住院時(shí)間,其中1篇國(guó)外研究、5篇國(guó)內(nèi)研究,共1498病例。結(jié)果顯示:與常規(guī)治療組比較,EGDT可縮短嚴(yán)重膿毒癥和膿毒性休克患者的ICU住院時(shí)間,差異有統(tǒng)計(jì)學(xué)意義,[SMD=-3.21,95%CI(-4.35,-2.08),P0.00001]。5.機(jī)械通氣時(shí)間共5篇研究報(bào)道了機(jī)械通氣時(shí)間,其中3篇國(guó)外研究、2篇國(guó)內(nèi)研究,共2583病例。結(jié)果顯示:與常規(guī)治療組比較,EGDT可縮短嚴(yán)重膿毒癥和膿毒性休克患者的呼吸支時(shí)間,差異有統(tǒng)計(jì)學(xué)意義,[OR=-0.98,95%CI(-1.28,-0.68),P0.00001]。研究結(jié)論 EGDT在降低嚴(yán)重膿毒癥和膿毒性休克患者28天病死率、60天病死率、縮短ICU住院時(shí)間和縮短機(jī)械通氣時(shí)間方面優(yōu)于常規(guī)治療,但其并不能改善嚴(yán)重膿毒癥和膿毒性休克患者的90天病死率。
[Abstract]:Early goal-directed therapy evaluation system research and analysis (early goal-directed therapy, EGDT) curative effect on the treatment of severe sepsis and septic shock, provide a reference for clinical research. Using the method of Cochran (Cochrane) of logarithmic systematic evaluation method according to Meta analysis. Electronic database search, collection of relevant literature research. Make detailed inclusion and exclusion criteria, randomized controlled trials (randomized controlled, trial, RCT) and prospective study of data analysis, and extract relevant data, analysis and conclusions of the report on results. Analysis of the effect of the main outcome measures include: 28 day mortality rate, the mortality rate of 60 days, the 90 day mortality rate ICU, the hospitalization time, the time of mechanical ventilation. The specific methods are as follows: (1) to "early goal-directed therapy", "bundle" early, "sepsis", "severe sepsis", "Septic shock" as Chinese search keywords, "early goal-directed therapy", "sepsis", "severe sepsis", "septic shock" as English search keywords, computer retrieval Pubmed, Nature, Science, China CNKI database, Wanfang database, VIP database, China biomedical literature databases and other electronic databases, collected in 2001 ~2015 published on the EGDT for the treatment of severe sepsis and septic shock in randomized clinical trials and prospective study. In the study group using EGDT test requirements, control group with conventional treatment. (2) the observer through reading the title excluding independent literature, repeated literature, animal experiments further through some literature. A retrospective study from reading literature, the same people published similar documents, in strict accordance with the standards into the final through the included 11 articles Research and data analysis. (3) provided by the Cochrane collaboration Review Manager 5.1.1 software for Meta analysis. The relative risk of the use of count data (odds ratio, OR) and 95%CI (confidence interval CI) as effect evaluation; continuous variable data using mean difference (mean, difference, MD) / standard mean difference (standandardized mean, difference, SMD and 95%CI) for evaluation of the effect of.P0.05 was statisticallysignificant. Pay attention to the heterogeneity between the studies and the heterogeneity is calculated, if the results of heterogeneity in the acceptable range, using fixed effect model; if the heterogeneity, the random effects model. To detect publication bias, and funnel plot, while Using Stata 12 software through Begg's method, Egger's method to detect the publication bias. The results included 11 studies, including 4 articles for foreign Study 7 for domestic research, 4687 cases were included, 2336 cases in group EGDT, 2351 cases of conventional treatment group. The main results are as follows.1.28 day mortality rate of a total of 6 studies reported mortality rate of 28 days, of which 3 studies, 3 domestic research, a total of 3483 cases. The results showed: the group with conventional treatment, EGDT may reduce the risk of severe sepsis and septic shock were 28 day mortality, the difference was statistically significant (0.49,0.97, [OR=0.69,95%CI) P=0.03].2.60, a total of 3 day mortality studies reported mortality rate of 60 days, are foreign research, a total of 2704 cases. The results show that: compared with the conventional the treatment group, EGDT may reduce the risk of severe sepsis and septic shock were 60 day mortality, the difference was statistically significant (0.44,0.97, [OR=0.66,95%CI) P=0.04].3.90, a total of 3 day mortality studies reported mortality rate of 90 days, are foreign research, a total of 3648 cases. The results showed that: EGDT group and No statistical significance in the conventional treatment group 90 day mortality between [OR=0.98,95%CI (0.84,1.14), P=0.76].4.ICU hospitalization time a total of 6 studies reported ICU hospitalization, 1 of which 5 domestic and foreign research, research, a total of 1498 cases. The results show that: compared with the conventional treatment group, EGDT can shorten the severe sepsis and sepsis toxic shock in the ICU hospitalization time, the difference was statistically significant (-4.35, [SMD=-3.21,95%CI, -2.08), mechanical ventilation time P0.00001].5. a total of 5 studies reported the duration of mechanical ventilation, 3 of which 2 domestic and foreign research, research, a total of 2583 cases. The results show that: compared with the conventional treatment group, EGDT can shorten the time of respiratory support severe sepsis and septic shock patients, the difference was statistically significant ([OR=-0.98,95%CI, -1.28, -0.68, P0.00001].) the research conclusion of EGDT in reducing severe sepsis and septic shock patients with the mortality rate of 28 days, 60 days Case fatality rate shortened ICU hospitalization time and shorter mechanical ventilation time than conventional treatment, but it could not improve the 90 day mortality of patients with severe sepsis and septic shock.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.7

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