多巴胺用药者不良反应发生率的meta分析

Incidences of Adverse Reactions in Patients Using Dopamine: A Meta-analysis

关键词:  多巴胺  不良反应  meta分析

Key words:  dopamine  adverse reactions  meta-analysis

摘要:

目的 了解多巴胺临床使用中不良反应的发生情况。方法 采用多巴胺、安全性、不良反应、不良事件、副反应和副作用检索词检索中国知网（CNKI）、万方数据库、维普数据库（VIP）、中国生物医学文献数据库（CBM）、PubMed、EMBASE、Cochrane Library和ClinicalTrials.gov等多个数据库，截止时间为2018年6月。应用meta分析对符合纳入标准的文献的不良反应发生率进行加权合并。结果 共68篇文献纳入分析，包括78个使用多巴胺的研究组。多巴胺临床使用的总不良反应发生率为17.2%（95% CI：9.2%~25.1%），发生率最高的不良反应为组织损伤或坏死（19.5%，95% CI：12.6%~26.4%），其次是心律失常（15.7%，95% CI：7.4%~24.0%）。重度不良反应发生率为7.3%（95% CI：3.6%~11.0%）。成人、小儿的总不良反应发生率分别为7.0%和15.1%，成人发生率最高的不良反应是心律失常（15.7%，95% CI：7.4%~24.0%），小儿发生率最高的不良反应是组织损伤或坏死（25.3%，95% CI：13.0%~37.6%）。高剂量组（>10 μg·kg^-1·min^-1）的不良反应发生率较高，为16.0%（95% CI：4.8%~27.3%）。不同剂型中，多巴胺粉针的不良反应发生率2.9%（95% CI：0.6%~5.1%）低于多巴胺水针（16.9%，95% CI：7.8%~26.0%）。结论 多巴胺注射液临床使用中不良反应发生率较高，不良反应类型多，临床使用中应密切监测。

Abstract:

OBJECTIVE To evaluate the incidences of adverse reactions in the clinical use of dopamine. METHODS Relevant studies available before June 2018 were identified by searching CNKI, WanFang, VIP, CBM, PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov using the following keywords:dopamine, safety, adverse reactions, adverse events, side effects and adverse effects. The incidences of adverse reactions in the included literatures were calculated by using meta-analysis. RESULTS A total of 68 studies (78 groups) were included. The incidence of total adverse reactions in the clinical use of dopamine was 17.2% (95% CI:9.2%-25.1%), and the highest incidence was tissue damage or gangrene (19.5%, 95% CI:12.6%-26.4%), followed by arrhythmia (15.7%, 95% CI:7.4%-24.0%). The incidence of severe adverse reactions was 7.3% (95% CI:3.6%-11.0%). The incidences of total adverse reactions in adults and children were 7.0% and 15.1%, respectively. The most common adverse reaction in adults was arrhythmia (15.7%, 95% CI:7.4%-24.0%) and the most common adverse reaction in children was tissue damage or gangrene (25.3%, 95% CI:13.0%-37.6%). The incidence of total adverse reactions was higher in the high dose group (>10 μg·kg^-1·min^-1), which was 16.0% (95% CI:4.8%-27.3%). Among the different dosage forms, the incidence of adverse reactions of dopamine powder injection was 2.9% (95% CI:0.6%-5.1%), which was lower than that of dopamine water injection (16.9%, 95% CI:7.8%-26.0%). CONCLUSION There are many types of adverse reactions in clinical use of dopamine and the incidences of adverse reactions are high. Dopamine should be closely monitored in clinical use.