当前位置： SCI文献检索 > CRITICAL CARE MEDICINE期刊下所有文献 > Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*.

Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*.

Abstract：

OBJECTIVES:There has long-been controversy about the possible superiority of norepinephrine compared to dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on outcome and adverse events in patients with septic shock. DATA SOURCES:A systematic search of the MEDLINE, Embase, Scopus, and CENTRAL databases, and of Google Scholar, up to June 30, 2011. STUDY SELECTION AND DATA EXTRACTION:All studies providing information on the outcome of patients with septic shock treated with dopamine compared to norepinephrine were included. Observational and randomized trials were analyzed separately. Because time of outcome assessment varied among trials, we evaluated 28-day mortality or closest estimate. Heterogeneity among trials was assessed using the Cochrane Q homogeneity test. A Forest plot was constructed and the aggregate relative risk of death was computed. Potential publication bias was evaluated using funnel plots. METHODS AND MAIN RESULTS:We retrieved five observational (1,360 patients) and six randomized (1,408 patients) trials, totaling 2,768 patients (1,474 who received norepinephrine and 1,294 who received dopamine). In observational studies, among which there was significant heterogeneity (p < .001), there was no difference in mortality (relative risk, 1.09; confidence interval, 0.84-1.41; p = .72). A sensitivity analysis identified one trial as being responsible for the heterogeneity; after exclusion of that trial, no heterogeneity was observed and dopamine administration was associated with an increased risk of death (relative risk, 1.23; confidence interval, 1.05-1.43; p < .01). In randomized trials, for which no heterogeneity or publication bias was detected (p = .77), dopamine was associated with an increased risk of death (relative risk, 1.12; confidence interval, 1.01-1.20; p = .035). In the two trials that reported arrhythmias, these were more frequent with dopamine than with norepinephrine (relative risk, 2.34; confidence interval, 1.46-3.77; p = .001). CONCLUSIONS:In patients with septic shock, dopamine administration is associated with greater mortality and a higher incidence of arrhythmic events compared to norepinephrine administration.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

De Backer D,Aldecoa C,Njimi H,Vincent JL

doi

10.1097/CCM.0b013e31823778ee

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

725-30

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

杂志文章,meta分析

在线工具

Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*.