双碳酸盐和其他缓冲疗法在急性代谢酸症:一个系统的审查和元分析
Peter C Lind1,2,3, Frederik G Hansen1,2, Mathias J Holmberg1,2
1Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Acta anaesthesiologica Scandinavica
|March 11, 2026
概括
在急性损伤的ICU患者中,急性代谢酸化的缓冲疗法可能会减少替代疗法的使用,但可能不会改善存活率. 对于心脏骤停,生存结果没有得到改善.
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.
- 心脏病学 心脏病学
背景情况:
- 急性代谢酸症是一种需要及时干预的危急状况.
- 缓冲疗法是一种常见的治疗方法,但它们的临床影响需要澄清.
- 需要综合证据来指导不同患者群体的临床决策.
研究的目的:
- 系统地审查和元分析缓冲疗法对急性代谢酸性疾病的成年患者临床结果的影响.
- 评估缓冲干预措施在不同重症监护环境中的影响,包括ICU,心脏骤停和手术内设置.
- 评估有关缓冲疗法的有效性和安全性的证据的确定性.
主要方法:
- 对于随机临床试验,在Embase,Cochrane和PubMed进行了全面的文献搜索.
- 两位独立审稿人评估了试验相关性,并提取了数据,使用Cochrane Risk of Bias 2工具评估了偏差风险.
- 用固定效果模型进行了元分析,通过GRADE方法评估证据确定性.
主要成果:
- 包括来自14项试验的15份手稿,重点关注重症患者,医院外心脏骤停和手术内酸性疾病.
- 在急性损伤的ICU患者中,缓冲疗法可能会减少替代疗法使用和血液感染,对生存没有显著影响 (低至中等确定性).
- 对于非医院心脏骤停,缓冲疗法对生存结果没有显著影响 (确定性非常低至低).
结论:
- 在急性损伤的ICU患者中,缓冲疗法在减少替代疗法需求方面可能有好处,但没有生存率.
- 对于患有医院外心脏骤停的患者,缓冲疗法似乎不会影响生存结果.
- 这一系统性审查提供了关于急性代谢酸症缓冲疗法的可靠综合证据,主要是在重症监护机构内.
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