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我们应该治疗重症患者的发热吗？三项随机对照试验的当前证据总结。

Should we treat fever in critically ill patients? A summary of the current evidence from three randomized controlled trials.

作者信息

Serpa Neto Ary, Pereira Victor Galvão Moura, Colombo Giancarlo, Scarin Farah Christina de la Cruz, Pessoa Camila Menezes Souza, Rocha Leonardo Lima

机构信息

Faculdade de Medicina do ABC, Santo André, SP, Brasil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.

出版信息

Einstein (Sao Paulo). 2014 Oct-Dec;12(4):518-23. doi: 10.1590/S1679-45082014RW2785. Epub 2014 Nov 18.

DOI:10.1590/S1679-45082014RW2785
PMID:25628209
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4879924/
Abstract

Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.

摘要

发热是对各种感染性或非感染性损伤的非特异性反应，其在疾病中的意义仍是一个谜。我们的目的是总结目前关于在重症患者中使用退热治疗的证据。我们对1966年至2013年发表的文献进行了系统评价和荟萃分析。检索MEDLINE和CENTRAL数据库以查找关于重症患者解热治疗的研究。荟萃分析限于：随机对照试验；成年重症患者；一组使用退热药治疗而另一组使用安慰剂或不治疗；以及死亡率数据报告。评估的结局指标包括重症监护病房总体死亡率、体温变化、重症监护病房住院时间和住院时间。纳入了三项随机对照试验，涉及320名参与者。与对照组相比，使用退热药物治疗的患者重症监护病房死亡率相似（风险比0.91，95%置信区间0.65-1.28）。观察到的唯一差异是使用退热药治疗的患者在24小时后体温下降幅度更大（-1.70±0.40对-0.56±0.25ºC；p=0.014）。在重症患者中治疗或不治疗发热没有差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4779/4879924/28e2fe36377d/1679-4508-eins-12-4-0518-gf03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4779/4879924/8be16ab32f32/1679-4508-eins-12-4-0518-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4779/4879924/28e2fe36377d/1679-4508-eins-12-4-0518-gf03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4779/4879924/8be16ab32f32/1679-4508-eins-12-4-0518-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4779/4879924/28e2fe36377d/1679-4508-eins-12-4-0518-gf03.jpg

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本文引用的文献

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The HEAT trial: a protocol for a multicentre randomised placebo-controlled trial of IV paracetamol in ICU patients with fever and infection.HEAT 试验：一项在 ICU 发热感染患者中使用 IV 对乙酰氨基酚的多中心随机安慰剂对照试验的方案。
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