成人急性呼吸窘迫症候群使用全身性類固醇之效益：隨機對照試驗之系統性文獻回顧統合分析

The Clinical Benefit of Systematic Corticosteroids in Adults with Acute Respiratory Distress Syndrome (ARDS): A Meta-analysis of Randomized Controlled Trials

王心瑜(Hsin-Yu Wang) ； 林孟怜(Meng-Lin Lin) ； 黎燕縈(Yen-Ying Lee)

《台灣實證醫學學會會刊》 10卷2期 (2019/12) Pp. 41-54

https://doi.org/10.6864/EC.201912_10(2).0011

摘要

目的：目前指引對類固醇用於急性呼吸窘迫症候群（ARDS）的效益仍沒有定論。本研究藉由系統性回顧統合分析，評估全身性類固醇使用於成人ARDS之治療效益。方法：使用PubMed、Embase、Cochrane Library等資料庫，搜尋全身性類固醇用於成人ARDS效益探討之隨機分派研究，進行系統性回顧分析。主要終點為總死亡率，次要終點為28天無使用呼吸器天數。結果：共7篇隨機分派研究納入總死亡率分析，全身性類固醇比安慰劑之總死亡率相對風險為0.74（95% CI: 0.58, 0.94; P=0.01）。6篇隨機分派研究於ARDS7天內投予全身性類固醇，與安慰劑相比之總死亡率相對風險為0.69（95% CI: 0.53, 0.90; P=0.006）。5篇隨機分派研究納入28天無使用呼吸器天數分析，全身性類固醇比安慰劑之天數平均差為3.4（95% CI: 1.45, 5.34; P=0.0006）。結論：ARDS發生後投予全身性類固醇可以降低總死亡率，且效益以7天內投予更為顯著。此外，投予全身性類固醇亦可增加28天無使用呼吸器天數。

關鍵字

成人 ； 急性呼吸窘迫症候群（ARDS） ； 全身性類固醇 ； 死亡率 ； 28天無使用呼吸器天數

並列摘要

Background: Objective: Current guidelines on the benefit of using corticosteroids in acute respiratory distress syndrome (ARDS) remain controversial. This study aimed to evaluate the clinical benefit of systematic corticosteroids in adults with ARDS by conducting a meta-analysis. Methods: A literature search was performed using PubMed, Embase, and Cochrane Library. Eligible studies included randomized controlled trials (RCTs) which investigated the benefit of systemic corticosteroids in adults with ARDS. The primary endpoint was overall mortality, and secondary endpoint was 28-day ventilator-free days. Results: A total of 7 RCTs were included for the analysis of overall mortality. Comparing corticosteroids with placebo, the overall mortality relative risk was 0.74 (95% CI: 0.58, 0.94; P=0.01). In the 6 RCTs where systemic corticosteroids were administered within 7 days from the onset of ARDS, the overall mortality relative risk was 0.69 (95% CI: 0.53, 0.90; P=0.006). The analysis of 28-day ventilator-free days was done in 5 RCTs; and the mean difference comparing corticosteroids with placebo was 3.4 (95% CI: 1.45, 5.34; P=0.0006). Conclusion: The administration of systemic corticosteroids reduced overall mortality in adults with ARDS, with more significant benefit in early administration within 7 days of ARDS onset. In addition, the administration of systemic corticosteroids also resulted in increased 28-day ventilator-free days.

並列關鍵字

adults ； acute respiratory distress syndrome (ARDS) ； systemic corticosteroids ； mortality ； 28-day ventilator-free days