多巴胺与去甲肾上腺素治疗感染性休克疗效比较的系统评价_《中国循证医学杂志》

作者：

赵阳 ¹ , 王倩 ² ,  臧彬 ¹

1. 中国医科大学附属盛京医院ICU（沈阳 110004）；2. 中国医科大学附属第四医院急诊科（沈阳 110032）;

关键词：

多巴胺去甲肾上腺素感染性休克随机对照试验系统评价 Meta分析

DOI：

10.7507/1672-2531.20120111

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的系统评价多巴胺与去甲肾上腺素治疗感染性休克的疗效及安全性。
方法计算机检索MEDLINE、EMbase、Cochrane图书馆、VIP、CNKI、CBM和WanFang Data等数据库（检索时限均从建库至2011年6月），纳入所有使用多巴胺或去甲肾上腺素治疗感染性休克的随机对照试验（RCT）。评价纳入研究的方法学质量和提取有效数据后，采用RevMan 5.1软件进行Meta分析。
结果共纳入9个RCT，3 179例休克患者。Meta分析结果显示：多巴胺同去甲肾上腺素相比，能使感染性休克患者住院期间死亡风险增加12%，其差异具有统计学意义［RR=1.12，95%CI（1.04，1.21），P=0.002］；多巴胺组感染性休克患者心率失常事件发生风险是去甲肾上腺素组的2.63倍［RR=2.63，95%CI（1.51，4.55），P=0.000 6］；多巴胺组心脏指数较去甲肾上腺素组增加［MD=0.42，95%CI（0.21，0.63），P lt;0.000 1］；但在心率［MD=17.05，95%CI（–0.71，34.81），P=0.06］及平均动脉压［MD=–0.87，95%CI（–24.97，7.62），P=0.30］方面，两组差异无统计学意义。
结论去甲肾上腺素同多巴胺相比能显著降低感染性休克患者住院期间死亡率，降低心律失常事件的发生率，其疗效及安全性优于多巴胺。

引用本文： 赵阳 ,王倩,臧彬. 多巴胺与去甲肾上腺素治疗感染性休克疗效比较的系统评价. 中国循证医学杂志, 2012, 12(6): 679-685. doi: 10.7507/1672-2531.20120111 复制

1.	Kampmeier TG, Rehberg S, Westphal M, et al. Vasopressin in sepsis and septic shock. Minerva Anestesiol, 2010, 76(10): 844-850.
2.	Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med, 2004, 30(4): 536-855.
3.	Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
4.	Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
5.	Povoa PR, Carneiro AH, Ribeiro OS, et al. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
6.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
8.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327: 557-560.
9.	Egger M, Altman DG, Smith GD. Systematic reviews in health-care: meta-analysis in context. 2nd edn. BMJ Books, Wiley: London, 2001.
10.	De Backer D, Biston P, Devriendt J, et al. SOAP II Investigators.Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med, 2010, 362(9): 779-789.
11.	Patel GP, Grahe JS, Sperry M, et al. Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock, 2010, 33(4): 375-380.
12.	Mathur SK, Dhunna R, Chakraborty A. Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography. Indian J Crit Care Med, 2007, 1(5): 186-191.
13.	Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
14.	Guérin JP, Levraut J, Samat-Long C, et al. Effects of dopamine and norepinephrine on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy balance in vasoplegic septic patients. Shock, 2005, 23(1): 18-24.
15.	Simon Grahe JJ, Patel GP, Elpern E, et al. The safety of dopamine versus norepinephrine as vasopressor therapy in septic shock (Abstract). Chest, 2005, 128: 219S-220S.
16.	Marik PE, Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA, 1994, 272(17): 1354-1357.
17.	Martin C, Papazian L, Perrin G, et al. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest, 1993, 103(6): 1826-1831.
18.	Ruokonen E, Takala J, Kari A, et al. Regional blood flow and oxygen transport in septic shock. Crit Care Med, 1993, 21(9): 1296-1303.
19.	Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
20.	Hamzaoui O, Georger JF, Monnet X, et al. Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care, 2010, 14(4): R142.
21.	Póvoa PR, Carneiro AH, Ribeiro OS, et al. Portuguese Community-Acquired Sepsis Study Group. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
22.	Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group: Low dose dopamine in patients with early renal dysfunction: a placebo controlled trial. Lancet, 2000, 356: 2139-2143.
23.	Argalious M, Motta P, Khandwala F, et al. “Renal dose” dopamine is associated with the risk of new-onset atrial fibrillation after cardiac surgery. Crit Care Med, 2005, 33(6): 1327-1332.
24.	Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation, 2008, 118: 1047-1056.

1. Kampmeier TG, Rehberg S, Westphal M, et al. Vasopressin in sepsis and septic shock. Minerva Anestesiol, 2010, 76(10): 844-850.
2. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med, 2004, 30(4): 536-855.
3. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
4. Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
5. Povoa PR, Carneiro AH, Ribeiro OS, et al. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
8. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327: 557-560.
9. Egger M, Altman DG, Smith GD. Systematic reviews in health-care: meta-analysis in context. 2nd edn. BMJ Books, Wiley: London, 2001.
10. De Backer D, Biston P, Devriendt J, et al. SOAP II Investigators.Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med, 2010, 362(9): 779-789.
11. Patel GP, Grahe JS, Sperry M, et al. Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock, 2010, 33(4): 375-380.
12. Mathur SK, Dhunna R, Chakraborty A. Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography. Indian J Crit Care Med, 2007, 1(5): 186-191.
13. Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
14. Guérin JP, Levraut J, Samat-Long C, et al. Effects of dopamine and norepinephrine on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy balance in vasoplegic septic patients. Shock, 2005, 23(1): 18-24.
15. Simon Grahe JJ, Patel GP, Elpern E, et al. The safety of dopamine versus norepinephrine as vasopressor therapy in septic shock (Abstract). Chest, 2005, 128: 219S-220S.
16. Marik PE, Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA, 1994, 272(17): 1354-1357.
17. Martin C, Papazian L, Perrin G, et al. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest, 1993, 103(6): 1826-1831.
18. Ruokonen E, Takala J, Kari A, et al. Regional blood flow and oxygen transport in septic shock. Crit Care Med, 1993, 21(9): 1296-1303.
19. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
20. Hamzaoui O, Georger JF, Monnet X, et al. Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care, 2010, 14(4): R142.
21. Póvoa PR, Carneiro AH, Ribeiro OS, et al. Portuguese Community-Acquired Sepsis Study Group. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
22. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group: Low dose dopamine in patients with early renal dysfunction: a placebo controlled trial. Lancet, 2000, 356: 2139-2143.
23. Argalious M, Motta P, Khandwala F, et al. “Renal dose” dopamine is associated with the risk of new-onset atrial fibrillation after cardiac surgery. Crit Care Med, 2005, 33(6): 1327-1332.
24. Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation, 2008, 118: 1047-1056.

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多巴胺与去甲肾上腺素治疗感染性休克疗效比较的系统评价

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《中国循证医学杂志》

多巴胺与去甲肾上腺素治疗感染性休克疗效比较的系统评价

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