右心室功能障碍在胸外心电图和长期死亡率在重症患者:一个系统的审查和元分析
Benjamin Gerhardy1,2,3, Shanthosh Sivapathan1,2, Emma Bowcock1,2
1Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia.
Journal of intensive care medicine
|December 6, 2023
概括
在重症患者中,右心室功能障碍 (RVD) 显著增加了长期死亡风险. 这一系统性审查强调了对标准化RVD定义和对其潜在机制的进一步研究的需要.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 心声回声图 (Echocardiography) 是一种心声回声图.
背景情况:
- 右心室功能障碍 (RVD) 是重症患者经常出现的并发症.
- 现有的关于RVD结果的研究存在不一致的定义和有限的随访时间.
- 目前的大部分文献都集中在特定的病理上,减少了对所有严重不良个体的概括性.
研究的目的:
- 进行系统审查和元分析.
- 评估通过胸前心声学 (TTE) 诊断的RVD对未经选择的重症患者的长期死亡率的影响.
- 为了比较RVD和无RVD患者的死亡率.
主要方法:
- 在EMBASE,Medline和Cochrane数据库中进行系统搜索 (开始至2022年3月).
- 包括所有使用TTE在重症或密集护理患者中的RVD定义,无论疾病如何.
- 随机效应模型分析使用德西米翁和莱尔德的逆方差方法.
主要成果:
- 包括16项研究 (3196名患者),确定了19个独特的RVD标准.
- 长期死亡率 (95% CI 1.92-4.54) 的概率比率 (OR) 增加了2.92倍.
- 孤立的RVD增加了延迟死亡的风险 (OR2.01,95% CI1.05-3.86).
结论:
- 无论其原因如何,RVD都与重症患者的长期死亡率增加有关.
- 在不同研究中,回声心脏学RVD定义的显著异质性引入了不确定性.
- 需要进一步的研究来阐明驱动RVD相关死亡率的病理生理机制.
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