在接受机械呼吸的患者中,ICU获得的虚弱的危险因素:系统性审查和元分析
Mingming Zhao1,2, Ya Fan2, Ting Wu2
1School of Medicine, Southeast University, Nanjing, China.
Journal of thoracic disease
|November 13, 2025
概括
皮质类固醇使用增加了在机械通风 (MV) 患者的重症监护室 (ICU) 获得的虚弱 (ICU-AW) 的风险. 关键的风险因素包括长时间的MV,晚年和高剂量的皮质类固醇使用.
科学领域:
- 关键护理医学 关键护理医学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在重症监护室 (ICU) 获得的虚弱 (ICU-AW) 是机械通风 (MV) 患者的常见并发症.
- 皮质类固醇 (CS) 暴露与ICU-AW之间的关联不一致,其他临床因素仍不清楚.
- 本研究调查了ICU-AW的风险因素,重点关注MV患者的CS使用.
研究的目的:
- 在接受机械通风 (MV) 的患者中,系统地审查和元分析与ICU-AW相关的风险因素.
- 专门研究使用皮质类固醇 (CS) 对ICU-AW发展的贡献.
- 为了确定特定的患者特征和临床因素,这些因素增加了这一群体的ICU-AW的风险.
主要方法:
- 在多个数据库 (PubMed,科学网,Embase,Cochrane图书馆,CNKI,万芳,VIP,CBM) 进行了系统的搜索,直到2024年12月.
- 使用纽卡斯尔-太华尺度 (NOS) 的队列研究的质量评估,并使用修订的Cochrane偏差风险工具 (ROB2) 评估随机对照试验 (RCT).
- 使用Stata 16软件进行了元分析.
主要成果:
- 分析包括2个RCT和19个队列研究,共计6894名患者.
- 在机械通风 (MV) 患者中,皮质类固醇 (CS) 的使用与急症监护室获得的虚弱 (ICU-AW) 发生率的增加显著相关 (RR = 1.52,95% CI: 1.31-1.76).
- 对ICU-AW的确定的风险因素包括长时间的MV持续时间,晚年,高剂量/长期使用CS,高血糖,乳酸升高,高APACHE II分数,更高的BMI和延长ICU停留时间 (LOS).
结论:
- 皮质类固醇 (CS) 的使用是ICU-AW在机械通风 (MV) 患者中获得的衰弱 (ICU-AW) 的重要危险因素.
- 与ICU-AW风险增加相关的特定患者特征包括MV持续时间≥8天,年龄≥60岁,长期高剂量CS使用 (≥1g),CS使用>7天,高血糖 (>13 mmol/L),乳酸水平升高 (≥4 mmol/L),APACHE II评分≥19,BMI≥24 kg/m2,ICU LOS>14天.
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