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Crit Care Med：低剂量与高剂量加压治疗对血管扩张性低血压的疗效比较

2022-11-28 MedSci原创 MedSci原创 发表于上海

加压治疗血管扩张性低血压
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在开始服用血管扩张性低血压的患者中，来自三个随机试验的中等确定性证据表明，较低的血管加压药物可能会降低死亡率。

平衡低血压和血管加压药相关不良反应的风险是ICU的日常挑战。近日，危重病医学领域权威杂志Critical Care Medicine上发表了一篇研究文章，研究人员进行了一项系统回顾和meta分析，以评估低剂量和高剂量加压治疗对血管扩张性低血压的成年ICU患者死亡率的影响。

研究人员检索了Ovid Medline、Embase和Cochrane中央对照试验登记中心，检索时间从数据库成立到2021年10月15日。研究人员纳入了在无语言或发表状态限制的成人ICU血管扩张性低血压患者中，较低与较高血管加压治疗的随机对照试验。

该研究的主要结局是90天全因死亡率，包括7个预先指定的亚组。次要结局包括短期和长期死亡率、维持生命疗法的使用、血管加压药相关并发症、神经结局和最长随访报告的生活质量。研究人员进行了随机效应元分析，以计算个体研究的总结效应度量（二元变量的风险比[RR]，连续变量的平均差异，均为95%CI）。使用建议分级、评估、发展和评估来评估证据的确定性。研究人员在国际前瞻性系统评论登记中心（CRD42021224434）注册了该综述。

在检索到的3403条记录中，研究人员审查了68篇全文文章，列入了3项合格研究。较低的血管加压药可能会降低90天死亡率，但这是基于中度确定性证据，因不精确而降低(RR为0.94;95%CI为0.87-1.02)。没有可信的亚组效应。较低的血管加压药物也可能降低室上性心律失常的风险(比值比为0.55;95%CI为0.36-0.86;低确定性)。

由此可见，在开始服用血管扩张性低血压的患者中，来自三个随机试验的中等确定性证据表明，较低的血管加压药物可能会降低死亡率。

 

原始出处：

Richards-Belle,et al.Lower Versus Higher Exposure to Vasopressor Therapy in Vasodilatory Hypotension: A Systematic Review With Meta-Analysis.critical care medicine.2022.https://journals.lww.com/ccmjournal/Fulltext/9900/Lower_Versus_Higher_Exposure_to_Vasopressor.71.aspx.

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    2022-11-28 delianjihui

    转化临床

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    2022-11-28 delianjihui

    转发学习

    0

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    2022-11-28 delianjihui

    感谢分享

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    2022-11-28 delianjihui

    学习受益

    0