治疗前阿片类药物对紧急输管过程中的血液动力学的影响:系统性审查
Rafael Von Hellmann1, Ian Ward A Maia2, Brian E Driver3
1Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.
概括
在紧急输入管之前的阿片类药物预治疗显示了有关输入管后低血压的相互矛盾的结果. 目前的证据有限,确定性非常低,强调需要进一步研究血液动力学不稳定性风险.
科学领域:
- 紧急医疗 紧急医疗
- 麻醉学 麻醉学
- 关键的护理关键的护理
背景情况:
- 在紧急情况下,阿片类药物预治疗用于在快速序列输管过程中管理血液动力学反应.
- 然而,阿片类药物可能会增加输管后低血压的风险,这是一种与增加发病率和死亡率相关的并发症.
- 由于对阿片类药物预治疗的净益处的不确定性,临床实践有所不同.
研究的目的:
- 评估阿片类药物预治疗与血液动力学不稳定性之间的关联,特别是输管后低血压.
- 综合来自随机对照试验和关于在紧急输管之前使用阿片类药物的观察性研究的证据.
主要方法:
- 随机对照试验和观察性研究的系统审查.
- 在主要数据库 (Cochrane,Embase,Medline,Scopus,Web of Science) 进行搜索,直到2024年11月.
- 包括接受紧急输管治疗的成年患者;不包括选择性手术. 评估了初级结局 (输管后低血压) 和二次结局 (低氧化,第一次尝试成功,心脏骤停,血管压缩剂使用).
主要成果:
- 包括8项研究 (6708名患者);2757人接受了阿片类药物,3951人没有.
- 在阿片类药物和对照组之间,输管后低血压的发生率差异很大.
- 一项单一的低风险随机研究表明阿片类药物增加了低血压 (OR 2.15),而观察性研究显示了不一致的结果. 在二次结果中没有观察到一致的差异.
结论:
- 目前关于紧急输管治疗的阿片类药物预治疗的证据有限且相互矛盾.
- 由于存在偏见,不一致性和不准确性的风险,证据的确定性非常低.
- 需要进一步进行高质量的研究,以澄清阿片类药物预治疗对血液动力学稳定的风险和益处.
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