皮质类固醇在非COVID-19诱导的社区获得性肺炎中,一个元分析
Jian Liu1, Yongquan Dong2, Jia Chen3
1Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
皮质类固醇治疗可能会减少严重社区获得性肺炎 (CAP) 的短期死亡率和住院时间. 虽然高血糖是危险的,但证据并不能阻止其在CAP患者中使用.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 对非COVID-19引起的社区获得性肺炎 (CAP) 进行皮质类固醇治疗的疗效尚未确定.
- 现有的研究对CAP患者使用皮质类固醇的益处和风险提出了不确定的发现.
研究的目的:
- 系统地评估皮质类固醇治疗在社区获得性肺炎管理中的作用和影响.
- 综合随机对照试验 (RCT) 的证据,以告知临床实践.
主要方法:
- 在PubMed,Embase和Cochrane数据库中对2000年1月1日至2023年5月5日之间发表的文章进行了全面的文献搜索.
- 分析了12个双盲RCT的数据,涉及2446名患者.
- 使用推评估,开发和评估分级 (GRADE) 方法评估证据质量.
主要成果:
- 皮质类固醇治疗显示出在严重CAP (sCAP) 患者中降低短期死亡率的潜力.
- 治疗与更短的住院时间和机械呼吸和败血症休克风险的降低有关.
- 没有观察到胃肠道出血或病房感染的显著差异,尽管高血糖症的风险增加.
结论:
- 对sCAP的皮质类固醇治疗可能有好处,特别是在减少短期死亡率方面,但需要进一步的证据才能得出最终的结论.
- 目前的证据并没有强烈反对在患有sCAP或患有sCAP进展风险的患者中使用皮质类固醇.
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