Curative Effect Of Glucocorticoid On The Acute Respiratory Distress Syndrome: A Meta Analysis

Background Acute respiratory distress syndrome(ARDS) is a very complicated clinical syndrome which caused by kinds of causative agents.Patients with ARDS were especially respiratory failure showed distress of respiratory and severe hypoxemia.Although cure primary affection,anti-inflammatory and respiration support was received to cure theARDS,the mortality is still high.PaO₂/FiO₂ can sufficiently evaluate oxygenation of patients(arterial partial pressure of oxygen+FiO₂) PaO₂/FiO₂ usualy is≥300,if it＜300 means that there is dysfunction of exchange in lung.And PaO₂/FiO₂ correctes with Qsp/Qt,so that it is used widely in the clincial treatment.Glucocorticoid had been used to cure the ARDS for a long time,but the cure efficacy is argument.Many researchers do not think it could decrease the mortality of ARDS.Evidence-Based Medicine(EBM) is a quickly developmented a subject with the Meta ananlysis was the most important measure.Meta analysis collects a sort of article which had same research objective,and to compare the research outcomes with different designed measure and cases by special design and statistics methods. Objective To evaluate the effects of glucocorticoid on the PaO₂/FIO₂ and mortality on patients with acute respiratory distress syndrome(ARDS),and to make sure of the curative effect of glucocorticoid on the ARDS.Methods Randomized controlled trial(RCTs) on the effects of glucocorticoid on the PaO₂/FIO₂ and mortality on patients with acute respiratory distress syndrome(ARDS) were identified from CBM,VIP,wangfang data,CNKI and pubmed(1997-2009).The keywords were glucocorticoids,dexamethasone,methylprednisolone,hydrocortisone,prednisone, acute respiratory distress syndrome,ARDS.All the proofs that demonstrated thes issues as the RCTs were included,and Revman 4.2 software was used for Meta analysis.Results In the research,there were 19 Chinese articles and 13 English articles,in which many articles were reviews.According the inclusion criteria of the research,there were ten articles could be analyzed by Revman 4.0 software.In the 10 artciles,the ARDS patients were diagnonsed by 1988 and 1995 Chinese ARDS diagnosis criteria and 1994 the American-European Consensus Corference on ARDS Ten RCTs were identified,which included 702 patients with ARDS(363 cases with glucocorticoid,339 cases without glucocorticoid),122 cases died in 363 cases with glucocorticoid,and 173 cases died in 339 cases with glucocorticoid.Total OR was 0.53 and 95%CI为0.38-0.47.In research of PaO₂/FIO₂,there was 6 RCTs included 547 patients with ARDS(321 cases with glucocorticoid,226 cases without glucocorticoid).The total 95%CIof PaO₂/FIO₂ was -11.53[-56.38,33.32],P＞0.05. After the sensitivity analysis,there is no a significnt diffecenct resuluts.Conclusions Glucocorticoid could significantly decrease the mortality of patients with ARDS,but could not increase the PaO₂/FIO₂,so that breathing support was still very important in the glucocorticoid treatment of ARDS.