系统评价代谢复苏干预在脓毒症患者中的应用效果OA

Objective To perform a Meta-analysis of the efficacy of hydrocortisone,ascorbic acid and thiamine(HAT)therapy in patients with sepsis.Methods A systematic search was conducted in China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,Embase,the Cochrane Library,and Web of Science to identify randomized controlled trials(RCT)evaluating HAT therapy for sepsis or septic shock,from database inception up to April 10,2025.Develop a retrieval strategy by combining subject headings and their synonyms,linked by Boolean operators,and adapted to the specific requirements of each database.Chinese search terms included"hydrocortisone""Vitamin C""ascorbic acid""Vitamin B1""thiamine""sepsis"and"septic shock";English search terms included"hydrocortisone""ascorbic acid""thiamine""Vitamin B1""Vitamin C""sepsis"and"septic shock".The control group received guideline-recommended standard sepsis bundle therapy,while the HAT combination therapy group received HAT therapy in addition to the standard care.The primary outcome was mortality;secondary outcomes included the change in sequential organ failure assessment(SOFA)score(ΔSOFA),duration of vasopressor therapy,and duration of mechanical ventilation.After literature screening and data extraction,the risk of bias in the included studies was assessed using ROB 2.0.Meta-analyses were performed using RevMan 5.4 and Stata 15.0.For dichotomous outcomes,relative risk(RR)with 95%confidence interval(95%CI)was calculated;for continuous outcomes,mean difference(MD)with 95%CI was used.An appropriate model for the Meta-analysis was selected based on the degree of heterogeneity.Results A total of 12 RCTs involving 2 033 patients were included.The Meta-analysis showed that,compared with the control group,HAT therapy did not significantly reduce overall mortality(RR=0.96,95%CI was 0.86-1.08,P=0.49).However,HAT therapy was associated with a significant improvement in organ function,as reflected by a reduction in the SOFA score(MD=-0.66,95%CI was-0.95 to-0.37,P<0.000 01),and a significant reduction in vasopressor duration(MD=-21.28,95%CI was-26.30 to-16.26,P<0.000 01).Subgroup analyses further demonstrated that HAT therapy significantly reduced SOFA scores at different time points(48,72,and 96 hours).No statistically significant differences were observed between the groups in terms of intensive care unit(ICU)length of stay,total hospital length of stay,or duration of mechanical ventilation.Conclusion Although HAT therapy did not significantly reduce mortality in septic patients,it significantly improved organ function and shortened the duration of vasopressor therapy,indicating potential clinical value.