在败血症和败血性休克中使用皮质类固醇:系统性审查,对照和剂量反应元分析
Tyler Pitre1, Katherine Drover2, Dipayan Chaudhuri3,4
1Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Critical care explorations
|January 22, 2024
概括
皮质类固醇可能会降低败血症的死亡率并改善冲击逆转,但可能会增加高血糖症,高血症和神经肌肉衰弱的风险. 最佳剂量是约260毫克/天的皮或同等剂量.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 败血症是一种危及生命的器官功能障碍,是由宿主对感染反应失调引起的.
- 皮质类固醇被用于治疗败血症,但它们的疗效和安全性仍有争议.
研究的目的:
- 系统地审查和分析皮质类固醇在败血症患者的疗效和安全性.
- 评估不同的皮质类固醇剂量对败血症结局的影响.
主要方法:
- 在PubMed,Embase和Cochrane图书馆数据库中进行了系统的搜索,截至2023年1月10日.
- 包括45个随机对照试验 (RCT),涉及9563名患者,将皮质类固醇与安慰剂或标准护理进行比较.
- 进行了对照和剂量反应元分析,使用GRADE指南进行确定性评估.
主要成果:
- 皮质类固醇可能会降低短期死亡率 (RR,0.93) 并增加7天后的冲击逆转 (RR,1.24) 具有很高的确定性.
- 潜在的不良事件包括高血糖症 (RR, 1.13) 和高血症 (RR, 1.64) 的风险增加,确定性中等.
- 剂量反应分析表明,用约260毫克/天的皮或同等剂量可降低最佳的死亡率.
结论:
- 皮质类固醇在减少败血症死亡率和改善冲击逆转方面可能是有益的.
- 然而,它们的使用与高血糖症,高血症和神经肌肉衰弱的风险增加有关.
- 对败血症的最佳皮质类固醇剂量似乎是约260毫克/天的皮或同等剂量.
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