预防重症患者急性损伤的液体复苏策略的比较有效性:一个元分析
Ihtesham Shafiq1, Margaret C Hastings1, Hieu Q Vo1
1Department of Medicine, Division of Med Nephrology, The University of Tennessee Health Science Center, Memphis, USA.
Cureus
|September 15, 2025
概括
液体复苏策略没有显著影响严重病情患者急性损伤 (AKI) 发生率或死亡率. 早期的目标导向治疗 (EGDT) 与更长的ICU停留时间有关,突出了优化流体管理的需要.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床试验 临床试验
背景情况:
- 急性损伤 (AKI) 是重症患者常见且严重的并发症,导致高发病率和死亡率.
- 有效的液体复苏对于管理重症患者至关重要,但最佳策略仍在争论中.
研究的目的:
- 为了比较不同的液体复苏策略在预防重症患者中AKI的有效性.
- 为了评估流体管理对死亡率的影响,需要置换疗法 (RRT),以及ICU停留时间.
主要方法:
- 在主要数据库 (PubMed,MEDLINE,EMBASE,Cochrane) 进行了系统的文献搜索,寻找相关的随机对照试验.
- 进行了一项随机效应元分析,汇集了来自8项涉及1390名患者的研究数据,计算了汇集的几率比率 (ORs) 和风险比率 (RRs).
主要成果:
- 在早期以目标为导向的治疗 (EGDT) 和常规护理 (OR 0.90,95% CI 0.71-1.13) 之间,或在晶体和体之间 (OR 1.03,95% CI 0.89-1.18),没有观察到AKI发病率的显著差异.
- 在所有比较的液体复苏策略中,死亡率和RRT的需要是相似的.
- 早期的目标导向治疗 (EGDT) 与通常护理相比,与显著更长的ICU停留 (MD 2.81天,95% CI 0.21-5.41) 相关.
结论:
- 目前的证据表明,各种液体复苏策略,包括EGDT与常规护理和晶体与合体,不会显著改变重症患者的AKI发病率,死亡率或RRT要求.
- 由于EGDT与长时间的ICU停留有关,因此需要进一步研究在重症监护机构中优化流体管理.
- 需要进行额外的研究,以完善重症患者的液体复苏方案,以改善结果.
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