在成年人中低剂量皮质的患者水平的元分析 感染性休克
Romain Pirracchio1, Djillali Annane2,3,4, Andre K Waschka5,6
1Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco.
NEJM evidence
|February 6, 2024
概括
皮质类固醇,如皮质,并没有降低败血症休克患者的死亡率. 这种患者层面的元分析没有发现显著的生存益处,尽管它可能会增加超血和肌肉衰弱的风险.
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.
- 流行病学 流行病学
背景情况:
- 之前的试验和元分析对于皮质类固醇在感染性休克管理中的有效性是不确定的.
- 患者层面的元分析为评估治疗效果提供了更精确的方法,特别是在子组中.
研究的目的:
- 为了对来自败血性休克试验的个体患者数据进行患者层面的元分析.
- 为了研究辅助静脉注射皮松在败血症休克中的疗效和安全性.
主要方法:
- 从17个符合条件的试验 (n=7882) 收集了个人患者的数据,调查了在败血症休克中静脉注射的皮.
- 主要结局:90天全因死亡率. 二级结局包括各种死亡率指标和无器官日.
- 还分析了诸如超级感染,肌肉衰弱和高血糖症等不良事件.
主要成果:
- 皮和安慰剂对90天死亡率没有显著降低 (RR 0.93;95% CI,0.82至1.04).
- 联合皮和皮显示出死亡率的好处 (RR 0.86;95% CI,0.79到0.92),但单独的皮没有.
- 观察到增加了无血管压缩剂的日子 (1.24天),但高血和肌肉衰弱的风险增加了.
结论:
- 在性休克患者中,皮作为辅助疗法与安慰剂相比,没有显著降低90天死亡率.
- 该研究没有发现患者子组之间有显著差异的治疗效应.
- 虽然不增加超级感染或出血风险,但由于可能增加超血和肌肉衰弱,水皮质的使用需要谨慎使用.
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