| Acute respiratory distress syndrome(ARDS)is still a problem plagued by clinicians,which clinical manifestation is intractable hypoxemia caused by non-cardiogenic pulmonary edema.The mortality rate of that is around 40%-60%.At present,ARDS remains a series of problems:the definition is unclear,the mechanism is unknown and no standard treatment.2012 the Berlin standard released,but there are still many deficiencies.Due to its pathogenesis is unclear,leading to treatment disordered.Although the mechanical ventilation achieved a certain effect,but there is still no evidence of drugs proved effect.Glucocorticoids are of concern to ARDS researchers because of their potential anti-inflammatory effects.Now,we review and evaluate the previous clinical studies,explore the efficacy and safety of glucocorticoids in ARDS,and explore the reasons for the high degree of heterogeneity in previous studies.Through the retrieval of PUBMED,Embase,WEB of Knowledge,Cochrane Library,according to the inclusion and screening criteria,we screen literatures,evaluate the quality of them and extract useful informations.The quality of the included literatures was evaluated according to the cochmae scale,and the STATA software was used for statistical analysis.According to I2 test to detect the heterogeneity of different clinical research results,select the fixed effect model or random effects model for analysis.The calculated data were calculated using the mean difference,and the count data were expressed as relative risk,and the 95%confidence interval was used to express the therapeutic effect.P<0.05 for the difference was statistically significant.From the 4024 clinical studies,we screen out seven clinical randomized controlled trials.Among them,a total of 550 patients,including hormone group 296 cases and placebo group of 254 cases.According to the results of the analysis,glucocorticoid had an improved effect on hospitalization mortality in patients with ARDS,with RR values of 0.454,95%CI(0.244,0.845)and Z = 2.49(p = 0.013);glucocorticoids increased UAB time.The SMD value was 0.459,95%CI(0.183,0.735),Z = 3.26,P = 0.001;the treatment of glucocorticoid in ARDS patients did not improve the oxygenation index with SMD of 2.289,95%CI(0.452,4.126),Z=2.44,P = 0.015.There were no statistically significant differences in the ICU mortality and side effects of corticosteroids,with P = 0.150 and P = 0.377 respectively.We concluded that:(1)glucocorticoids can improve hospital mortality in ARDS patients;(2)glucocorticoids can prolong UAB time in patients;(3)low doses of glucocorticoids cannot improve oxygenation;(4)Corticosteroids do not increase the risk of nosocomial infection in ARDS patients.In addition,according to the results,we give recommendations:(1)the study should base on different pathogens.ARDS patients with different pathogens have different reactions to the treatment of cortisol;(2)the end of the study should be carried out in a longer period of time,such as 60 days mortality and 180 days mortality;(3)explore the different reactions for the first time to give glucocorticoid treatment.ARDS patients may have different benefits;(4)the endpoint should be more clear:mortality,off-line time,side effects and so on. |
PDF Full Text Request