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Intens Care Med:重症流感肺炎患者给予皮质类固醇疗效如何?

2018-08-05 xing.T MedSci原创

由此可见,重症流感肺炎患者给予皮质类固醇治疗与ICU死亡率增加有关,这些药物不应作为这类患者的辅助治疗。

近日,危重病医学领域权威杂志Intensive Care Medicine上发表了一篇研究文章,研究人员旨在确定与重症流感肺炎患者皮质类固醇激素相关的临床预测因子及其与ICU死亡率之间的关系。

2009年6月至2014年4月期间,研究人员对西班牙148个ICU中确诊为流感肺炎危重患者的前瞻性队列研究进行二次分析。不是因病毒性肺炎而接受皮质类固醇治疗的患者(例如难治性脓毒性休克和哮喘或慢性阻塞性肺疾病[COPD]恶化)被排除在外。研究人员将皮质类固醇治疗的患者与未接受皮质类固醇治疗的患者进行了比较,并使用倾向得分(PS)匹配分析来减少混淆因素。该研究的主要结局是ICU死亡率。研究人员进行Cox比例风险和竞争风险分析以评估皮质类固醇对ICU死亡率的影响。

该研究共招募了1846名原发性流感肺炎患者。接受皮质类固醇治疗的患者有604名(32.7%),甲基强的松龙是最常用的皮质类固醇(578/604 [95.7%])。中位日剂量相当于80毫克甲基强的松龙(IQR 60-120),中位持续时间为7天(IQR 5-10)。哮喘、COPD、IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%202" target="_blank">血液疾病和机械通气与皮质类固醇的使用独立相关。接受糖皮质激素治疗的患者(27.5%)的粗略ICU死亡率高于未接受皮质类固醇治疗的患者(18.8%,p<0.001)。PS匹配后,在Cox分析(HR=1.32[95%CI为1.08-1.60],p<0.006)和竞争风险分析(SHR=1.37 [95%CI为1.12-1.68],p=0.001)中,皮质类固醇使用与ICU死亡率相关。

由此可见,重症流感肺炎患者给予皮质类固醇治疗与ICU死亡率增加有关,这些药物不应作为这类患者的辅助治疗。

原始出处:

Gerard Moreno, et al. Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study.Intensive Care Medicine.2018. http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=5332_10.1007_s00134-018-5332-4&doi=

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    2018-08-08 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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    2018-08-07 衣带渐宽

    学习

    0

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    2018-08-07 张新亮1853311252142e2fm

    好文章学习了好文章学习了

    0

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    2018-08-05 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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