允许性低血压对液体平衡或功能没有有害影响
Jean-Rémi Lavillegrand1,2, Laurene Blum1, Alexandra Morin1
1Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Critical care explorations
|October 23, 2023
概括
允许性低血压,即平均动脉压在55至65毫米平之间,对于没有输血不足的败血症患者来说是安全的. 这种方法避免了血管压缩剂和过量的液体,没有增加损伤.
科学领域:
- 临界护理医学 临界护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 败血症病理生理学病理生理学
背景情况:
- 败血症管理指南建议目标是65mmHg或更高的平均动脉压 (MAP).
- 允许MAP在55至65mmHg之间在没有低 perfusion 迹象的败血症患者中的安全性和后果仍然不清楚.
- 在允许的低血压下了解液体平衡和功能对于优化败血症护理至关重要.
研究的目的:
- 评估允许性低血压 (MAP 55-65 mm Hg) 对败血症患者的液体平衡和功能的安全性和影响.
- 为了比较与允许低血压管理的败血症患者与需要血管压缩剂治疗败血症休克患者之间的结果.
主要方法:
- 连续的一年内被录入第三级教学医院ICU的败血症患者的回顾性分析.
- 尽管进行了液体复苏,但MAP<65mmHg的患者被分为两组:允许性低血压 (MAP55-65mmHg没有外周低血流) 和败血性休克 (MAP用北上腺素纠正).
- 收集的数据包括人口统计数据,感染源,序列器官衰竭评估 (SOFA) 评分,液体输入,尿液输出以及损伤的KDIGO评分.
主要成果:
- 包括94名患者,15名患者在容许性低血压组,79名患者在败血症冲击组.
- 败血症冲击组的SOFA分数 (p < 0.0001) 和死亡率 (38%对0%,p < 0.01) 较高.
- 允许性低血压患者在前6小时内获得的液体较少 (p = 0.03),尿量较高 (p < 0.001),48小时后KDIGO得分较低 (p < 0.05).
结论:
- 平均动脉低血压在55到65mmHg之间可以在没有临床外周输血的情况下安全地容忍败血症患者.
- 这种称为允许性低血压的策略不需要使用血管压缩剂,并且与减少液体输入和较少的损伤有关.
- 允许性低血压似乎是选择性败血症患者的安全和潜在有益的方法,需要进一步调查.
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