皮质类固醇治疗感染性休克:一把双刃剑。

IF 3.4 3区 医学 Q1 CRITICAL CARE MEDICINE
Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-06-27 DOI:10.1097/MCC.0000000000001297
Jane Y Wang, Marin H Kollef
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引用次数: 0

摘要

综述目的:在脓毒性休克的治疗中,皮质类固醇治疗仍然存在争议。糖皮质激素在免疫调节和拯救下丘脑-垂体-肾上腺(HPA)轴失调方面的潜在益处使其成为临床研究的一个有吸引力的目标。然而,相互矛盾的试验结果给临床指导带来了不确定性,而危害风险仍然是一个问题。这篇综述总结和解释了目前关于皮质类固醇治疗在感染性休克中的作用的证据,并提出了未来继续研究的方向。最新发现:更新的指南继续推荐在感染性休克中使用皮质类固醇,但在社区获得性肺炎(CAP)和急性呼吸窘迫综合征(ARDS)中出现了更可靠的皮质类固醇数据,这可能解释了在感染性休克试验中看到的一些益处。系统评价表明与氟化可的松联合治疗的潜在益处,但需要进一步的研究。不同提供者和ICU设置的皮质类固醇处方实践存在显著差异。总结:关于皮质类固醇在感染性休克中的应用仍有许多不确定因素。然而,在利大于弊的情况下,它们仍然是治疗难治性休克的合适患者的工具。未来的研究应侧重于皮质类固醇治疗的个体化方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Corticosteroids in septic shock: a double-edged sword.

Purpose of review: Corticosteroid therapy remains controversial in the management of septic shock. The putative benefits of glucocorticoids on immunomodulation and rescue of hypothalamic-pituitary-adrenal (HPA) axis dysregulation has made it an attractive target for clinical research. However, conflicting trial results have introduced uncertainty into clinical guidance, while risk of harm continues to be a concern. This review summarizes and interprets the current body of evidence for the role of corticosteroid therapy in septic shock and suggests future directions for continued investigation.

Recent findings: Updated guidelines continue to recommend corticosteroids in septic shock, but more robust data for corticosteroids have emerged in community acquired pneumonia (CAP) and acute respiratory distress syndrome (ARDS), which may account for some of the benefit seen in trials on septic shock. Systematic reviews have suggested potential benefits of combination therapy with fludrocortisone, but further research is needed. Significant variation exists in corticosteroid prescribing practices across providers and ICU settings.

Summary: Many uncertainties remain regarding utility of corticosteroids in septic shock. However, they remain a tool for refractory shock in appropriate patients where benefits outweigh harm. Future research should focus on individualized approaches to corticosteroid therapy.

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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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