附加性血管压缩剂和在成年人中患有败血性休克的短期死亡:系统性审查和元分析
Seth R Bauer, Patrick M Wieruszewski, Brittany D Bissell Turpin
1Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
Shock (Augusta, Ga.)
|February 18, 2025
概括
在败血性休克中,辅助血管抑制剂可能会降低死亡率和替代疗法,但会增加缺血和静脉血栓栓塞的风险. 证据的确定性很低,质疑美国目前的使用模式.
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.
- 临床试验 临床试验
背景情况:
- 辅助血管压缩剂经常与成年人败血症休克中使用诺亚上腺素.
- 治疗指南缺乏关于其有效性的直接证据.
- 当前的做法可能与现有证据基础不一致.
研究的目的:
- 综合直接证据,在败血症休克中使用辅助血管压缩剂.
- 评估对短期死亡率和关键次要结果的影响.
- 评估治疗对益处和危害的证据的确定性.
主要方法:
- 随机临床试验的系统审查和元分析.
- 在2023年6月之前搜索的主要数据库 (MEDLINE,Embase,Cochrane).
- 包括17项试验,包括3813名成年参与者,将辅助血管压缩剂与标准护理进行比较.
主要成果:
- 辅助血管抑制剂可能会降低短期死亡率 (RR 0.92,低确定性).
- 可能减少对置换治疗的需要 (RR 0.92,中等确定性).
- 可能增加数字/外周缺血的风险 (RR 2.44,低确定性) 和静脉血栓栓塞 (RR 16.48,低确定性).
结论:
- 在败血症休克中,辅助血管压缩剂对死亡率和功能显示出潜在的益处.
- 增加不良事件的风险需要仔细考虑.
- 证据的确定性低,与美国使用率高的情况形成鲜明对比.
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