多巴胺與去甲腎上腺素治療感染性休克療效比較的系統評價_《中國循證醫學雜志》

作者：

趙陽 ¹ , 王倩 ² ,  臧彬 ¹

1. 中國醫科大學附屬盛京醫院ICU（沈陽 110004）；2. 中國醫科大學附屬第四醫院急診科（沈陽 110032）;

關鍵詞：

多巴胺去甲腎上腺素感染性休克隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20120111

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目的系統評價多巴胺與去甲腎上腺素治療感染性休克的療效及安全性。
方法計算機檢索MEDLINE、EMbase、Cochrane圖書館、VIP、CNKI、CBM和WanFang Data等數據庫（檢索時限均從建庫至2011年6月），納入所有使用多巴胺或去甲腎上腺素治療感染性休克的隨機對照試驗（RCT）。評價納入研究的方法學質量和提取有效數據后，采用RevMan 5.1軟件進行Meta分析。
結果共納入9個RCT，3 179例休克患者。Meta分析結果顯示：多巴胺同去甲腎上腺素相比，能使感染性休克患者住院期間死亡風險增加12%，其差異具有統計學意義［RR=1.12，95%CI（1.04，1.21），P=0.002］；多巴胺組感染性休克患者心率失常事件發生風險是去甲腎上腺素組的2.63倍［RR=2.63，95%CI（1.51，4.55），P=0.000 6］；多巴胺組心臟指數較去甲腎上腺素組增加［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］及平均動脈壓［MD=–0.87，95%CI（–24.97，7.62），P=0.30］方面，兩組差異無統計學意義。
結論去甲腎上腺素同多巴胺相比能顯著降低感染性休克患者住院期間死亡率，降低心律失常事件的發生率，其療效及安全性優于多巴胺。

引用本文： 趙陽 ,王倩,臧彬. 多巴胺與去甲腎上腺素治療感染性休克療效比較的系統評價. 中國循證醫學雜志, 2012, 12(6): 679-685. doi: 10.7507/1672-2531.20120111 復制

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.

《中國循證醫學雜志》

多巴胺與去甲腎上腺素治療感染性休克療效比較的系統評價

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《中國循證醫學雜志》

多巴胺與去甲腎上腺素治療感染性休克療效比較的系統評價

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