Sherwin Robert Leigh, Garcia Audwin J, Bilkovski Robert
Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA.
J Emerg Med. 2012 Jul;43(1):7-12. doi: 10.1016/j.jemermed.2011.08.015. Epub 2012 Jan 4.
The management of septic shock has undergone a significant evolution in the past decade. A number of trials have been published to evaluate the efficacy of low-dose corticosteroid administration in patients with septic shock.
The Sepsis Sub-committee of the American Academy of Emergency Medicine Clinical Practice Committee performed an extensive search of the contemporary literature and identified seven relevant trials.
Six of the seven trials reported a mortality outcome of patients in septic shock. Analysis of the data revealed that the relative risk (RR) of 28-day all-cause mortality in septic shock patients who received low-dose corticosteroids was 0.92 (95% confidence interval [CI] 0.79-1.07). All seven trials reported data concerning shock reversal or the withdrawal of vasopressors. Pooled results revealed that the RR of shock reversal is 1.17 (95% CI 1.07-1.28), which suggests that there may be significant improvement in shock reversal after corticosteroid administration. It is important to understand that two of the seven studies reviewed were disproportionately represented and accounted for 799 of 1005 patients (80%) considered for this recommendation.
The evidence suggests that low-dose corticosteroids may reverse shock faster; however, mortality is not improved for the overall population.
在过去十年中，感染性休克的管理发生了重大演变。已经发表了多项试验来评估低剂量皮质类固醇给药对感染性休克患者的疗效。
美国急诊医学学会临床实践委员会脓毒症小组委员会对当代文献进行了广泛检索，并确定了七项相关试验。
七项试验中的六项报告了感染性休克患者的死亡率结果。数据分析显示，接受低剂量皮质类固醇治疗的感染性休克患者28天全因死亡率的相对风险（RR）为0.92（95%置信区间[CI]0.79 - 1.07）。所有七项试验都报告了有关休克逆转或血管升压药撤药的数据。汇总结果显示，休克逆转的RR为1.17（95%CI 1.07 - 1.28），这表明皮质类固醇给药后休克逆转可能有显著改善。需要注意的是，所审查的七项研究中有两项占比过高，在考虑该建议的1005名患者中有799名（80%）来自这两项研究。
证据表明，低剂量皮质类固醇可能更快逆转休克；然而，总体人群的死亡率并未改善。
