NEJM:感染性休克患者早期靶向治疗效果如何?

2017-03-22 xing.T MedSci原创

在这项对个体病人数据进行的荟萃分析中,EGDT并不会比常规治疗产生更好的结局,并且与所有特点的患者和医院的较高住院费用有关。

在一个单中心临床试验和观察性研究提示早期目标导向治疗(EGDT)可以降低感染性休克死亡率后,三个多中心试验(ProCESS、ARISE和ProMISe)显示无效益。最近,顶级医学期刊NEJM上发表了一篇荟萃分析文章,研究人员对最近的三个前瞻性试验的个体患者数据进行荟萃分析,以提高统计效能并探索EGDT治疗效果的异质性。

研究人员统一了研究准入标准、干预方案、结局、资源利用的指标、并通过试验数据的收集,并在揭盲前明确所有分析。试验完成后,研究人员汇总了数据,排除了ProCESS研究基于协议的标准治疗组,并分析残留差异。该研究的主要结局为90天死亡率。次要结局包括1年生存率、器官支持和住院费用。研究人员检验了16个病人的特点的治疗亚组相互作用和6个护理服务特性。

研究人员分析了七个国家138家医院的3723名病人。研究人员发现90天的死亡率在EGDT治疗组(1852例中的462例[24.9%])和常规治疗组(1871例中的475例[25.4%])相似;调整后的比值比为0.97(95%可信区间为0.82-1.14;P=0.68)。EGDT相比于常规治疗与较高的平均(±SD)使用重症监护(5.3±7.1 vs. 4.9±7天,P=0.04)和血管支持(1.9±3.7 vs. 1.6±2.9天,P=0.01)有关;而其他的结局没有显著差异,尽管EGDT治疗的平均成本较高。亚组分析显示休克更严重的患者(高血清乳酸水平,合并低血压和高乳酸血症,或更高的死亡预测风险)或复苏期间使用升压药或液体治疗倾向性较低的医院并没有从EGDT治疗中获得效益。

在这项对个体病人数据进行的荟萃分析中,EGDT并不会比常规治疗产生更好的结局,并且与所有特点的患者和医院的较高住院费用有关。

原始出处:

Giovanni Landoni, et al. Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis. N Engl J Med 2017; http://www.nejm.org/doi/full/10.1056/NEJMoa1616325#t=abstract

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    2017-03-25 laoli

    学习了,谢谢!

    0

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    2017-03-23 1e0ece0dm09(暂无匿称)

    谢谢指点迷津

    0

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    2017-03-22 万里江山一孤舟

    学习了

    0

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    2017-03-22 1e15b6fem30(暂无匿称)

    很好的学习资料,谢谢了。

    0

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    2017-03-22 明天会更好!

    学习了!!!

    0

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    2017-03-22 18521084327暂无昵称

    学习了

    0

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