评估复发性低血压在患有感染性休克的患者中随着血管压缩剂中止策略后的复发性低血压
Skyler Starkel1, Brian R Schuler1, Mary P Kovacevic1
1Brigham and Women's Hospital, Boston, MA, USA.
The Annals of pharmacotherapy
|April 24, 2025
概括
在感染性休克患者中,首先停止使用诺拉上腺素或血管压素,在六小时内不会影响低血压风险. 这一发现表明,血管压缩剂取消的顺序可能不会显著影响感染性休克管理的临床结果.
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:
- 目前的生存性败血症指南建议初步选择血管压缩剂,但缺乏关于停药顺序的数据.
- 以前的研究表明,首先停止血管压素会增加短期低血压风险,但较短的时间框架在临床上更相关.
研究的目的:
- 为了比较复发性低血压的发生率在停止使用诺拉上腺素后6小时内与败血症休克患者的血管压素相比.
- 为了研究血管压缩剂中止序列对短期血液动力学稳定性的影响.
主要方法:
- 从2021年1月到2021年12月,对209名成年败血症休克患者进行了单中心的回顾性分析.
- 根据是否首先停止服用诺拉上腺素 (NE1) 或血管压素 (AVP1) 来分组患者.
- 主要结局:第一个血管压缩剂停止后6小时内低血压的发生率;次要结局包括ICU停留时间,死亡率和冲击分辨率.
主要成果:
- 在NE1和AVP1组之间,在6小时内低血压发生率没有显著差异 (54%对61%,p=0.1).
- 卡普兰-梅尔分析显示,在6小时内降低血压的时间没有差异.
- 在12-24小时低血压,ICU停留时间,ICU死亡率或冲击分辨率方面没有观察到差异.
结论:
- 这是第一个在性休克中6小时窗口内检查血管压缩剂停止顺序的研究.
- 停止使用诺拉上腺素或压缩剂的顺序似乎不会影响早期反弹低血压的发生率.
- 提供了临床保证,血管压缩剂取消的顺序可能不会影响关键患者的结果.
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