在ARDS中,早期与晚期的2 mg/kg甲基prednisolone治疗相比
Justine Verchère1,2, Damien Barrau3,4,5, Jonathan Chelly6
1Médecine Intensive et Réanimation, Hôpital Nord, Centre Hospitalier Universitaire, Assistance Publique Hôpitaux de Marseille, Chemin des Bourrely, 13915, Marseille, France. vercherejustine@gmail.com.
Scientific reports
|November 1, 2025
概括
对急性呼吸困扰综合征 (ARDS) 的延迟皮质类固醇治疗不会增加死亡率. 这项研究发现,在ARDS患者14天后启动甲基普雷迪尼索隆显示出类似的生存率,但更多的并发症,如VAP.
科学领域:
- 肺部病理学 肺部病理学
- 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.
背景情况:
- 在急性呼吸窘迫综合征 (ARDS) 中,持续的炎症和纤维扩散会影响结果.
- 皮质类固醇治疗在ARDS中的作用受到辩论,人们担心延迟服用会增加死亡风险.
研究的目的:
- 在ARDS患者中评估延迟2mg/kg甲基普雷迪尼索隆治疗的疗效和安全性.
- 为了比较早期 (<14天) 和晚期 (>14天) 开始甲基prednisolone治疗的结果.
主要方法:
- 在392名ARDS患者接受2mg/kg甲基prednisolone的观察性,多中心,回顾性研究中.
- 主要终点:6个月死亡率. 二级终点:60天死亡率,无呼吸器日 (VFDs),无ICU日,并发症率 (VAP,败血症,肠道出血).
主要成果:
- 在6个月死亡率 (51.9%早期 vs. 52.2%晚期,p=0.942) 或60天死亡率 (47.1%早期 vs. 47.3%晚期,p=0.968) 中没有显著差异.
- 两组之间没有显著差异的VFDs或ICU-free天.
- 晚期开始 (>14天) 与更高的并发症发生率有关,包括呼吸机肺炎 (VAP) 和胃肠道出血.
结论:
- 在ARDS发病后14天以上开始2mg/kg甲基普雷迪尼索隆治疗与死亡率的增加无关.
- 对于持久性ARDS患者,可以考虑推迟甲基普雷迪尼索隆治疗,但应监测潜在的并发症风险增加.
相关概念视频
COPD: Management Using Bronchodilators and Corticosteroids
713
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
713
Acute Respiratory Failure-II
1.0K
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
1.0K
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
1.5K
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
1.5K


