在心力衰竭的败血症患者中基于指导方针和受限制的液体复苏策略:系统性审查和元分析
Ali Vaeli Zadeh1, Alan Wong2, Andrew Carl Crawford2
1Holy Cross Health, Heart Failure Research Services, Fort Lauderdale, FL, United States of America; University of Miami at Holy Cross Hospital, Fort Lauderdale, FL, United States of America.
The American journal of emergency medicine
|August 19, 2023
概括
对于心力衰竭的败血症患者 (<30毫升/千克IV晶体在3小时内) 的限制性液体复苏策略显著增加了住院死亡风险. 基于指导方针的液体复苏对于这个脆弱的人群至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 败血症研究 败血症研究
背景情况:
- 败血症管理指南建议在3小时内至少使用30毫升/千克IV晶体.
- 对于有心力衰竭 (HF) 史的败血症患者,最佳的液体复苏策略仍在争论中.
- 由于潜在的液体过载风险,心力衰竭复杂化了败血症的管理.
研究的目的:
- 在有心力衰竭史的败血症患者中,基于指导方针 (≥30毫升/千克) 和限制性 (<30毫升/千克) 液体复苏策略之间的住院死亡率进行比较.
- 分析早期液体复苏体积对这一特定患者亚组的死亡率的影响.
主要方法:
- 在Embase,PubMed和Scopus上对2016年以来发表的研究进行了系统的文献搜索.
- 包括的研究集中在心力衰竭的败血症患者身上,并报告了与30毫升/千克的3小时 (30x3) 液体复苏目标相关的医院死亡率数据.
- 对4项选定的研究进行了元分析,以评估液体复苏策略与死亡率之间的关联.
主要成果:
- 分析包括4项研究,分析了有心力衰竭史的败血症患者的数据.
- 接受限制性液体复苏 (3小时内<30毫升/千克) 的患者与达到指南目标 (OR = 1.81,P = 0.01) 的患者相比,住院死亡风险明显更高.
结论:
- 限制性液体复苏与心力衰竭败血症患者的住院死亡率增加有关.
- 需要进行进一步的研究,为这种高风险人群建立明确的最佳液体复苏方案.
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