左西孟旦对心力衰竭危重患者死亡率影响的Meta分析

摘要

目的:研究左西孟旦对心力衰竭(心衰) 危重患者死亡率的影响.方法:在PubMed、EMBASE、Cochrane心血管组数据库中收集左西孟旦与其他干预措施的随机对照研究,文献检索时间从各数据库建库时间至 2014-07.根据Jadad量表评价纳入文献的质量并提取资料.对符合质量标准的对照研究(无剂量及给药方式的限制)采用 Rev Man 5.2 进行Meta 分析.根据纳入标准最终入选37篇文献,共入选病例 4 470例.结果:左西孟旦与对照组相比能降低心脏相关疾病所致心衰危重患者的死亡率[危险比(RR):0.85; 95%可信区间(CI):0.75~0.97;P=0.02],并能降低心脏手术所致心衰危重患者的死亡率(RR:0.49;95% CI:0.28~0.85;P=0.01).与多巴酚丁胺进一步比较,左西孟旦能降低心衰危重患者的死亡率(RR:0.84;95%CI:0.73~0.98;P=0.02),并能降低缺血性心脏病所致心衰危重患者的死亡率(RR:0.85;95%CI:0.73~0.99;P=0.04).结论:左西孟旦能降低心脏相关疾病、心脏手术及缺血性心脏病所致心衰危重患者的死亡率.%Objective: To investigate the impact of levosimendan on mortality in patients with severe heart failure (HF) by Meta-analysis. Methods: We search the PubMed, EMBASE and Cochrane Central Registry of cardiovascular disease to identify all randomized impact of levosimendan vs other medications. The document retrieval was from the establishment of each database until 2014-07. The literatures were taken based on Jadad scale standard and the qualified control study was used without dose and time restrictions by Rev Man 5.2 soft ware, and a total of 37 articles with 4470 patients were finally enrolled for Meta-analysis. Results: Compared with controlling medications, levosimendan could decrease the mortality in patients with cardiac disease caused severe HF (RR: 0.85; 95% CI 0.75-0.97;P=0.02), and cardiac surgery caused severe HF (RR: 0.49; 95% CI 0.28-0.85;P=0.01). Compared with dobutamine, levosimendan could reduce the mortality in patients with severe HF (RR: 0.84; 95% CI 0.73-0.99;P=0.02) and severe ischemic HF (RR: 0.85; 95% CI 0.73-0.99;P=0.04). Conclusion: Levosimendan may reduce the mortality in patients with severe HF caused by cardiac disease, cardiac surgery and ischemic cardiac injury.