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皮质类固醇治疗急性呼吸窘迫综合征。

Corticosteroids for ARDS.

机构信息

Medical Intensive Care Unit, Massachusetts General Hospital, Boston, MA 02114, USA.

出版信息

Minerva Anestesiol. 2010 Jun;76(6):441-7.

Abstract

The aim of this study was to describe the role of glucocorticoids in immune modulation during critical illness and to review clinical trials and recent meta-analyses of glucocorticoids in early and late acute respiratory distress syndrome (ARDS). Selected reviews of publications, clinical trials, and meta-analyses were considered for the study. Activation of the adrenal axis is an important component of the compensatory anti-inflammatory response to critical illness. A recent meta-analysis of high doses of corticosteroids in patients with or at risk for ARDS demonstrated a trend for greater risk of the development of ARDS and a fatal outcome. Additional meta-analyses of four randomized trials and five cohort studies in patients with established ARDS or pneumonia indicated an overall mortality benefit with corticosteroids but this finding was not confirmed in another meta-analysis limited to randomized trials and excluding the trial focused on pneumonia. Lung function is improved and the duration of mechanical ventilation is reduced with prolonged administration of lower doses. In conclusion, short-duration, high-dose glucocorticoid therapy is not effective in preventing ARDS and may be harmful. Lower doses for persistent ARDS improve lung function and shorten the duration of mechanical ventilation but the impact on long-term mortality is unclear. Additional trials are needed to determine if corticosteroids improve important clinical outcomes before they can be recommended for the routine use of patients with unresolved ARDS.

摘要

本研究旨在描述糖皮质激素在危重病免疫调节中的作用,并对糖皮质激素在早期和晚期急性呼吸窘迫综合征(ARDS)中的临床研究和最新荟萃分析进行综述。研究考虑了出版物、临床试验和荟萃分析的精选综述。肾上腺轴的激活是对危重病补偿性抗炎反应的重要组成部分。最近对 ARDS 或有 ARDS 风险的患者进行的大剂量皮质类固醇的荟萃分析表明,ARDS 发展和致命结局的风险增加。对已确诊的 ARDS 或肺炎患者的四项随机试验和五项队列研究的其他荟萃分析表明,皮质类固醇具有总体死亡率获益,但在另一项仅限于随机试验和排除针对肺炎的试验的荟萃分析中,这一发现并未得到证实。延长低剂量皮质类固醇的应用可改善肺功能并缩短机械通气时间。总之,短期、大剂量糖皮质激素治疗不能预防 ARDS,且可能有害。持续 ARDS 的低剂量可改善肺功能并缩短机械通气时间,但对长期死亡率的影响尚不清楚。需要进一步的试验来确定皮质类固醇是否可以改善未解决的 ARDS 患者的重要临床结局,然后才能推荐其常规使用。

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