低剂量皮质类固醇在肝硬化患者的感染性休克或血管压缩剂依赖性休克:一个系统性审查和元分析
Leonardo Corrêa Süffert1, Enzo Arthur Bruno Pergher1, Henrique Steffens de Abreu1
1School of Medicine, Pontifical Catholic University of Rio Grande do Sul - Porto Alegre, Brazil.
Journal of critical care
|December 18, 2025
概括
低剂量皮质类固醇在患有冲击的肝硬化患者中没有改善存活率,但确实改善了冲击解消并降低了与冲击相关的死亡率. 然而,这种治疗可能会增加胃肠道出血和新器官衰竭等不良事件的风险.
科学领域:
- 关键护理医学 关键护理医学
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 败血性休克和血管压缩剂依赖的分布性休克是危及生命的疾病,特别是在肝硬化患者中.
- 在这个人群中使用低剂量皮质类固醇是有争议的,因为潜在的益处和风险.
研究的目的:
- 评估低剂量皮质类固醇在感染性或血管压缩剂依赖的分布性休克的肝硬化患者的临床益处和对住院死亡率的影响.
主要方法:
- 随机对照试验 (RCT) 和观察性研究的系统审查和元分析.
- 在PubMed,Embase和Cochrane CENTRAL数据库中进行了搜索.
- 分析了结果,包括住院死亡率,耐震死亡率,冲击解消,无血管压缩剂的日子和不良事件.
主要成果:
- 包括6项研究 (2项RCT,4项观察性) 涉及514名患者.
- 皮质类固醇没有显著影响住院死亡率 (RR:0.99;95% CI:0.86-1.13).
- 益处包括减少耐震性死亡率 (RR:0.16;95% CI:0.06-0.41) 和增加冲击分辨率 (RR:1.42;95% CI:1.13-1.78).
- 观察到胃肠道出血的风险增加 (RR: 2.73;95% CI: 1.15-6.52) 和新的器官衰竭 (RR: 1.42;95% CI: 1.01-1.99).
结论:
- 低剂量的皮质类固醇在发生震荡的肝硬化患者中提供有限的临床益处.
- 虽然它们提高了冲击分辨率和降低了与冲击相关的死亡率,但它们并没有改善整体存活率.
- 严重不良事件的潜在增加需要仔细考虑风险-收益.
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