CC:接受短效β受体阻滞剂治疗的脓毒症患者的死亡率：一项全面的随机对照试验的荟萃分析

Abstract

Background: Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.在脓毒症患者中使用短效β受体阻滞剂的治疗仍然存在争议。两项最近的大规模多中心试验为这种治疗方法提供了额外的证据。因此，我们进行了一项包括最新数据的荟萃分析，以评估短效β受体阻滞剂治疗对成年脓毒症患者死亡率的潜在影响。

Methods: The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.数据搜索包括PubMed、Web of Science、ClinicalTrials.gov和Cochrane Library。根据PRISMA声明，对所有符合条件的同行评审研究进行了荟萃分析。只包括随机、对照研究，这些研究对脓毒症有有效的分类，并且通过静脉注射短效β受体阻滞剂（兰地洛尔或艾司洛尔）进行治疗。短期死亡率作为主要终点。次要终点包括对短期死亡率的影响，特别是关于患者年龄和心律的影响。

Results: A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, – 0.10 [95% CI, – 0.22 to 0.02]; p = 0.11; p for Cochran’s Q test = 0.001; I² = 73%). No difference was seen when comparing patients aged < 65 versus ≥ 65 years (p = 0.11) or sinus tachycardia with atrial fibrillation (p = 0.27). Despite statistical heterogeneity, no significant publication bias was observed.共有七项研究，总结了854名患者，符合预定义的标准并被纳入。与参考治疗相比，短效β受体阻滞剂治疗对短期死亡率和汇总死亡率（死亡率数据最长的时期）没有显著影响（风险差异，-0.10 [95% CI，-0.22至0.02]；p=0.11；Cochran’s Q检验的p值为0.001；I²=73%）。在比较年龄<65岁与≥65岁的患者时没有发现差异（p=0.11），或者在窦性心动过速与房颤患者之间也没有差异（p=0.27）。尽管存在统计学异质性，但没有观察到显著的发表偏倚。

Conclusion: Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.在持续性心动过速的脓毒症患者中，短效β受体阻滞剂的使用并没有降低短期死亡率。未来的研究还应提供广泛的血流动力学数据，以便在治疗前后对心脏功能进行表征。