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Intens Care Med:全身性皮质类固醇激素对危重成年人胃肠道出血发生率的影响

2019-09-23 xing.T MedSci原创

由此可见,该研究可观察到成年重症患者临床上胃肠道大出血的总体发生率较低。皮质类固醇治疗可能会稍微增加临床上胃肠道大出血的发生率,但不会增加任何严重程度的出血。事件较罕见、很少的试验报告和偏倚的高风险降低了证据的质量。

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,研究人员旨在评估全身性皮质激素治疗对成年危重症患者肠道出血发生率的影响。

研究人员系统地回顾了比较了成年危重症患者全身性皮质类固醇激素治疗24小时以上与安慰剂/不治疗的随机临床试验。试验选择、数据抽象和偏倚评估风险由两名研究者独立进行。研究人员使用试验序贯分析(TSA)来评估随机错误的风险,并使用推荐、评估、发展和评价等级(GRADE)方法来评估证据的质量。该研究的主要结局是90天内临床肠道大出血的发生率。次要结局是90天内任何严重程度的胃肠道出血发生率。

该分析中共有25项试验(n=14615)报道了主要结局的数据,而55项试验(n=21792)报道了次要结局数据。皮质类固醇组临床上胃肠道大出血的合并发生率为2.3%,对照组为1.8%(RR为1.26;95%CI为1.01-1.57; I2=0%,TSA调整后的CI为0.51-3.14)。研究人员观察到任何严重程度的胃肠道出血风险均无差异(RR为1.10;95%CI为0.92-1.32;I2=0%,TSA调整后的CI为0.87-1.38)。GRADE的证据质量较低(存在偏倚和不精确的风险)。

由此可见,该研究可观察到成年重症患者临床上胃肠道大出血的总体发生率较低。皮质类固醇治疗可能会稍微增加临床上胃肠道大出血的发生率,但不会增加任何严重程度的出血。事件较罕见、很少的试验报告和偏倚的高风险降低了证据的质量。  

原始出处:

Ethan Butler,et al.The effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in critically ill adults: a systematic review with meta-analysis.Intensive Care Medicine.2019.https://www.esicm.org/icm-search/?id=doi:10.1007/s00134-019-05754-3#article

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    2019-09-26 1209e435m98(暂无昵称)

    学习了

    0

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    2019-09-24 医者仁心5538

    学习了

    0

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