在败血症和社区获得的肺炎中使用皮质类固醇
Amedeo Guzzardella1,2, Ana Motos3, Jordi Vallverdú4
1Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain.
Medizinische Klinik, Intensivmedizin und Notfallmedizin
|December 5, 2023
概括
皮质类固醇可能有助于减少炎症并更快地解决败血症休克,但它们对败血症总体死亡率的影响尚不清楚. 未来的研究应该集中在精准医学上,以确定最佳的皮质类固醇使用.
科学领域:
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 败血症和败血性休克导致高死亡率,尽管抗生素,往往涉及过度的宿主免疫反应和皮质类固醇缺乏.
- 之前的高剂量皮质类固醇试验没有显示出死亡益处,并且增加了不良事件.
- 最近的低剂量,较长时间的皮质类固醇研究表明,冲击缓解速度更快,并减少了炎症,副作用很少,尽管死亡率的好处并不确定.
研究的目的:
- 审查皮质类固醇治疗在败血症和败血性休克中不断变化的作用和疗效.
- 分析不同皮质类固醇剂量策略对患者结局的影响.
- 突出目前的指导方针和新兴的精准医学方法,用于治疗败血症的皮质类固醇使用.
主要方法:
- 对治疗败血症和败血症休克的皮质类固醇治疗的临床试验和元分析的综述.
- 分析历史数据,比较高剂量与低剂量皮质类固醇治疗方案.
- 包括最近关于败血症表型受益于皮质类固醇的发现.
主要成果:
- 高剂量的皮质类固醇 (在2000年之前) 没有提供生存优势,并增加了风险.
- 低剂量,较长时间使用的皮质类固醇 (2000年后) 加快了冲击解消和减少了炎症,并具有可控的副作用.
- 在所有研究中都始终没有表明对整体死亡率有重大影响.
结论:
- 目前的指导方针建议在特定的败血症和严重肺炎患者中使用皮质类固醇.
- 通过隐性类分析进行表型鉴定对于精确定位从皮质类固醇中获益最多的患者至关重要.
- 需要精确医学方法来确定特定患者群体的最佳皮质类固醇剂量和持续时间.
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