心源性休克的血管活性药物治疗:重要综述。

IF 2.4
Journal of Drug Assessment Pub Date : 2021-07-20 eCollection Date: 2021-01-01 DOI:10.1080/21556660.2021.1930548
Rasha Kaddoura, Amr Elmoheen, Ehab Badawy, Mahmoud F Eltawagny, Mohamed A Seif, Khalid Bashir, Amar M Salam
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引用次数: 0

摘要

背景:心源性休克(CS)是一种急性复杂病症,可导致发病率和死亡率。血管活性药物,如血管加压药和肌注药被认为是 CS 药物治疗的基石,可通过增加心输出量(CO)和血压(BP)改善终末器官灌注,从而防止多器官衰竭:目的:对目前可用的 CS 血管活性药物随机研究进行批判性回顾分析,以确定每种药物的适应症,并对研究的方法学质量进行批判性评估:方法:在 PubMed 数据库中进行检索,以确定 CS 中血管活性疗法的随机对照试验 (RCT)。在对研究进行筛选后,采用三项目 Jadad 量表对所选研究的内部有效性进行了严格评估:结果:9 项研究随机选取了 2388 名患者,平均年龄介于 62 岁至 69 岁之间。其中七项研究调查了急性心肌梗死(AMI)情况下的 CS。这些研究评估了去甲肾上腺素(NE)与多巴胺、肾上腺素与去甲肾上腺素、左西孟丹与多巴酚丁胺、依诺昔蒙或安慰剂以及一氧化氮合酶抑制剂(NOSi)与安慰剂之间的比较。九项研究的平均 Jadad 得分为 3.33,只有三项研究的得分达到 5.结论:血管活性药物治疗 CS 的研究证据存在不确定性。结论:血管活性药物在 CS 中的研究证据存在不确定性,由于在 CS 中开展研究本身就存在困难,因此各研究之间的方法学质量参差不齐。由于缺乏药物替代品,血管加压药和肌注药仍然发挥着重要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Vasoactive pharmacologic therapy in cardiogenic shock: a critical review.

Vasoactive pharmacologic therapy in cardiogenic shock: a critical review.

Vasoactive pharmacologic therapy in cardiogenic shock: a critical review.

Vasoactive pharmacologic therapy in cardiogenic shock: a critical review.

Background: Cardiogenic shock (CS) is an acute complex condition leading to morbidity and mortality. Vasoactive medications, such as vasopressors and inotropes are considered the cornerstone of pharmacological treatment of CS to improve end-organ perfusion by increasing cardiac output (CO) and blood pressure (BP), thus preventing multiorgan failure.

Objective: A critical review was conducted to analyze the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies.

Methods: PubMed database search was conducted to identify randomized controlled trials (RCTs) on vasoactive therapy in CS. After study selection, the internal validity of the selected studies was critically appraised using the three-item Jadad scale.

Results: Nine studies randomized 2388 patients with a mean age ranged between 62 and 69 years, were identified. Seven of studies investigated CS in the setting of acute myocardial infarction (AMI). The studies evaluated the comparisons of norepinephrine (NE) vs. dopamine, epinephrine vs. NE, levosimendan vs. dobutamine, enoximone or placebo, and nitric oxide synthase inhibitors (NOSi) vs. placebo. The mean Jadad score of the nine studies was 3.33, with only three studies of a score of 5.

Conclusions: The evidence from the studies of vasoactive agents in CS carries uncertainties. The methodological quality between the studies is variable due to the inherent difficulties to conduct a study in CS. Vasopressors and inotropes continue to have a fundamental role given the lack of pharmacological alternatives.

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来源期刊
Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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