Vasopressin and terlipressin in adult vasodilatory shock a systematic review and meta-analysis of nine randomized controlled trials 英文参考文献.docVIP

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Vasopressin and terlipressin in adult vasodilatory shock a systematic review and meta-analysis of nine randomized controlled trials 英文参考文献.doc

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Vasopressin and terlipressin in adult vasodilatory shock a systematic review and meta-analysis of nine randomized controlled trials 英文参考文献

SerpaNetoetal.CriticalCare2012,16:R154 /content/16/4/R154 RESEARCH OpenAccess Vasopressinandterlipressininadultvasodilatory shock:asystematicreviewandmeta-analysisof ninerandomizedcontrolledtrials ArySerpaNeto1*,Ant?nioPNassarJúnior2,SérgioOCardoso1,JoséAManetta1,VictorGMPereira1, DanielCEspósito1,MariaCTDamasceno1andJamesARussell3 Abstract Introduction:Catecholaminesarethemostusedvasopressorsinvasodilatoryshock.However,thedevelopmentof adrenergichyposensitivityandthesubsequentlossofcatecholaminepressoractivitynecessitatethesearchfor otheroptions.Ouraimwastoevaluatetheeffectsofvasopressinanditsanalogterlipressincomparedwith catecholamineinfusionaloneinvasodilatoryshock. Methods:Asystematicreviewandmeta-analysisofpublicationsbetween1966and2011wasperformed.The MedlineandCENTRALdatabasesweresearchedforstudiesonvasopressinandterlipressinincriticallyillpatients. Themeta-analysiswaslimitedtorandomizedcontrolledtrialsevaluatingtheuseofvasopressinand/orterlipressin comparedwithcatecholamineinadultpatientswithvasodilatoryshock.Theassessedoutcomeswere:overall survival,changesinthehemodynamicandbiochemicalvariables,adecreaseofcatecholaminerequirements,and adverseevents. Results:Ninetrialscovering998participantswereincluded.Ameta-analysisusingafixed-effectmodelshoweda reductioninnorepinephrinerequirementamongpatientsreceivingterlipressinorvasopressininfusioncompared withcontrol(standardizedmeandifference,-1.58(95%confidenceinterval,-1.73to-1.44);P0.0001).Overall, vasopressinandterlipressin,ascomparedwithnorepinephrine,reducedmortality(relativerisk(RR),0.87(0.77to 0.99);P=0.04).Vasopressincomparedwithnorepinephrinedecreasedmortalityinadultpatients(RR,0.87(0.76to 1.00);P=0.05)andinpatientswithsepticshock(42.5%vs.49.2%,respectively;RR,0.87(0.75to1.00);P=0.05; numberneededtotreat,1to15).Therewasnodifferenceinadverseeventsbetweenthevasopressinandcontrol groups(RR,0.98(0.65to1.47);P=0.92). Conclusions:Vasopressinuseinvasodilatoryshockissafe,associatedwithreducedmortality,andfacilit