利尿剂,死亡率,以及急性功能不恢复的急性功能衰竭
Ravindra L Mehta1, Maria T Pascual, Sharon Soroko
1Division of Nephrology, University of California, San Diego, Medical Center, USA.
JAMA
|November 28, 2002
概括
利尿剂可能会增加急性功能衰竭患者死亡和不恢复的风险. 这项研究表明,在患有急性损伤的重症患者中,不建议使用利尿剂,因为可能会造成伤害.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
背景情况:
- 急性功能衰竭 (ARF) 是一种严重的疾病,死亡率高.
- 在ARF中使用利尿剂缺乏支持证据,可能是有害的.
研究的目的:
- 调查尿剂使用与ARF重症患者的结局之间的关联.
- 为了确定利尿剂在这个患者群体中是否有好处或风险.
主要方法:
- 一项队列研究涉及552名在四个学术医疗中心患有ARF的重症患者.
- 患者根据在脏病咨询和第一周的尿剂使用情况进行了分类.
- 评估的结果包括全因医院死亡率和功能不恢复.
主要成果:
- 在咨询时,59%的患者服用了利尿剂.
- 利尿剂的使用与老年患者,患有充血性心力衰竭和毒性ARF的患者有关.
- 经过调整后的分析显示,利尿剂的使用显著增加了死亡或不恢复的风险 (OR, 1.77).
- 对利尿药不反应的患者和排除早期死亡的患者的风险更高.
结论:
- 在重症ARF患者中服用利尿剂与死亡率增加和脏不恢复有关.
- 研究结果表明,利尿剂没有显著的益处,可能会有害.
- 该研究建议在没有强有力的临床试验证据的情况下,在ARF中不鼓励广泛使用利尿剂.
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