血管扩展性休克的成年人血压目标 - 一个个体患者数据元分析
Federico Angriman1,2,3, Neda Momenzade4, Neill K J Adhikari1,2
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
NEJM evidence
|November 18, 2024
概括
较低的平均动脉血压目标可能会降低患有血管扩张性休克的危急病患者的90天死亡率. 然而,证据的确定性很低,不能排除潜在的危害.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 临床试验和元分析
背景情况:
- 血管扩张性休克是一种需要血管压缩剂支持的危急状况.
- 优化平均动脉血压 (MAP) 目标对于患者的治疗结果至关重要.
- 对于重症患者的最佳MAP目标存在不确定性.
研究的目的:
- 为了比较一个较低的MAP目标与一个较高的MAP目标对90天全因死亡率的影响.
- 分析来自随机对照试验 (RCT) 在血管扩张性休克中对MAP目标的数据.
- 为了确定较低的MAP目标是否会降低严重病情的成年人死亡率.
主要方法:
- 三个RCT (SEPSISPAM,OVATION,65-Trial) 的个人患者数据元分析.
- 包括3352名患有血管扩展性休克的危急病的成年患者.
- 贝叶斯随机效应日志-二项式模型用于估计90天死亡风险比率.
主要成果:
- 与较高的目标相比,较低的MAP目标显示90天死亡率的风险比为0.93 (95% CrI,0.761.07).
- 对于较低的MAP目标,后期获益的概率为87%,证据确定性低.
- 没有确定特定从更高的MAP目标中受益的子组.
结论:
- 针对较低的MAP可能会降低血管扩展性休克90天死亡率.
- 证据支持较低的MAP目标的确定性很低.
- 分析并没有排除MAP目标较低的潜在整体危害.
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