败血症和上腺功能衰竭
Cosmo Fowler1, Nina Raoof1, Stephen M Pastores1
1Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Journal of intensive care medicine
|June 27, 2023
概括
败血症中的关键疾病相关皮质类固醇缺乏症 (CIRCI) 在诊断和治疗中呈现非特异性症状和挑战. 本综述综合了对皮质类固醇使用的证据,重点关注冲击持续时间,死亡率和不良影响.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 传染病 传染病 传染病
背景情况:
- 败血症可能导致严重疾病相关的皮质类固醇缺乏症 (CIRCI),原因是下丘脑-垂体-上腺轴调节失调,皮质醇代谢发生变化和葡萄糖皮质类固醇耐药性.
- 败血症中的CIRCI呈现出非特异性症状,如精神状态变化,发烧和耐火性低血压,通常需要血管压缩剂.
- 尽管已被认可十多年来,CIRCI仍然不太了解,难以诊断,并与各种临床实践有关皮质类固醇治疗.
研究的目的:
- 为了提供一个全面的,基于证据的审查,目前的建议诊断和管理CIRCI在败血症.
- 探索围绕在败血症和败血症休克中使用皮质类固醇的现有争议.
- 突出新出现的证据和CIRCI管理的未来方向.
主要方法:
- 现有文献的综述,包括过去四十年来对治疗败血症和败血症休克时使用皮质类固醇的数十项随机对照试验.
- 综合证据关于皮质类固醇对冲击持续时间,死亡率和不良事件的影响.
- 分析CIRCI目前的诊断和管理策略.
主要成果:
- 在败血症和败血性休克中,皮质类固醇治疗始终减少了休克的持续时间.
- 皮质类固醇对败血症死亡率的影响在研究中仍然不一致.
- 与皮质类固醇使用相关的不良反应包括高血糖症,神经肌肉衰弱和感染风险增加.
结论:
- 在败血症中CIRCI的管理需要仔细考虑好处 (减少冲击持续时间) 与风险 (不一致的死亡益处,不良影响).
- 需要进一步的研究,以澄清最佳的皮质类固醇剂量和持续时间的败血症诱导的CIRCI.
- 随着证据的不断发展,CIRCI在重症患者中的临床实践继续受到影响.
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