低血压危重症成年患者升压药血压靶向调控应用的系统回顾
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension.
背景与目的
临床医师必须辩证的考虑低血压带来的风险和使用升压药物可能存在的副作用。专家指出平均动脉压目标值应保持不低于65mmHg，但老年患者和患有慢性高血压以及动脉粥样硬化的患者可适度维持较高的血压。本研究将系统性的评价随机对照试验中低血压危重症患者较高血压或较低血压靶控输注升压药时的差异。
方 法
本研究检索了 MEDLINE和EMBASE数据控以及Cochrane 临床试验注册中心中有关比较高血压靶控输注和较低血压靶控输注升压药治疗低血压危重症成年患者的情况。由两位成员根据文献题目和摘要独立的判断是否符合纳入标准，最后再根据全文内容行进一步的筛查。预先设定好选取的相应结局指标和亚组分型，并采用GRADE系统（推荐等级的评估，处理以及评价）评估干预措施效果的整体置信度等级。
结 果
最初总共检索到8001篇文献，随后下载阅读57篇全文，最终仅2篇随机对照试验（包含894名患者）符合纳入标准。本研究结果显示，低血压危重症成年患者中较高血压靶控输注升压药与降低死亡率（相对危险度[RR] 1.05；95% 置信区间[CI],0.90-1.23;P=0.54）无关，同时改良总体效应结果也显示其与年龄（P=0.17）和慢性高血压（P=0.32）无关。然而，低血压危重症成年患者中较高血压靶控输注升压药与新近发生的室上速型心律失常风险的增加有关（RR,2.88; 95% CI 1.28-3.38;P＜0.01）。
结 论
当前的数据并不支持低血压危重症成年患者MAP＞70mmHg时需要进行升压药治疗。
原始文献摘要
Hylands M, Moller M H, Asfar P, et al. A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension.[J]. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017,64(7):703-715. DOI:10.1007/s12630-017-0877-1
PURPOSE: Clinicians must balance the risks from hypotension with the potential adverse effects of vasopressors. Experts have recommended a mean arterial pressure (MAP) target of at least 65 mmHg, and higher in older patients and in patients with chronic hypertension or atherosclerosis. We conducted a systematic review of randomized-controlled trials comparing higher vs lower blood pressure targets for vasopressor therapy administered to hypotensive critically ill patients.
METHODS: We searched MEDLINE(R), EMBASE, and the Cochrane Central Register of Controlled Trials for studies of higher vs lower blood pressure targets for vasopressor therapy in critically ill hypotensive adult patients. Two reviewers independently assessed trial eligibility based on titles and abstracts, and they then selected full-text reports. Outcomes, subgroups, and analyses were prespecified. We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rate the overall confidence in the estimates of intervention effects.
RESULTS: Of 8001 citations, we retrieved 57 full-text articles and ultimately included two randomized-controlled trials (894 patients). Higher blood pressure targets were not associated with lower mortality (relative risk [RR], 1.05; 95% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01).
CONCLUSION: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.
麻醉学文献进展分享
联系我们