CCM:短效β受体阻滞剂对感染性休克患者预后的影响：一项系统综述和荟萃分析

Abstract

Objectives: 

To determine the impact of short-acting beta-blocker therapy on outcomes in adult patients with septic shock.确定短效β受体阻滞剂治疗对成人脓毒性休克患者预后的影响。

Data Sources: 

We searched MEDLINE, Embase, and unpublished sources from inception to April 19, 2024.我们检索了MEDLINE、Embase和未发表的资料，检索时间从建库至2024年4月19日。

Study Selection: 

We included randomized controlled trials (RCTs) that evaluated short-acting beta-blockers compared with usual care in patients with septic shock.我们纳入了评估短效β受体阻滞剂与常规治疗在脓毒性休克患者中应用的随机对照试验（RCTs）。

Data Extraction: 

We collected data regarding study and patient characteristics, beta-blocker administration, and clinical, hemodynamic, and biomarker outcomes.我们收集了有关研究和患者特征、β受体阻滞剂给药以及临床、血流动力学和生物标志物结局的数据。

Data Synthesis: 

Twelve RCTs proved eligible (n = 1170 patients). Short-acting beta-blockers may reduce 28-day mortality (relative risk [RR], 0.76; 95% CI, 0.62–0.93; low certainty) and probably reduce new-onset tachyarrhythmias (RR, 0.37; 95% CI, 0.18–0.78; moderate certainty) but may increase the duration of vasopressors (mean difference [MD], 1.04 d; 95% CI, 0.37–1.72; low certainty). Furthermore, there is an uncertain effect as to whether short-acting beta blockers impact 90-day mortality (RR, 0.98; 95% CI, 0.73–1.31), ICU length of stay (MD, –0.75 d; 95% CI, –3.43 to 1.93 d), hospital length of stay (MD, 1.03 d; 95% CI, –1.92 to 3.98 d), duration of mechanical ventilation (MD, –0.10 d; 95% CI, –1.25 to 1.05 d) (all very low certainty), bradycardia episodes (RR, 3.14; 95% CI, 0.91–14.01), and hypotension episodes (RR, 4.74; 95% CI, 1.62–14.01) (all very low certainty).12项RCT符合纳入标准（n = 1170例患者）。短效β受体阻滞剂可能降低28天死亡率（相对风险[RR]，0.76；95%置信区间[CI]，0.62–0.93；低确定性），并可能减少新发快速性心律失常（RR，0.37；95% CI，0.18–0.78；中等确定性），但可能延长血管加压药的使用时间（平均差异[MD]，1.04天；95% CI，0.37–1.72；低确定性）。此外，短效β受体阻滞剂对90天死亡率（RR，0.98；95% CI，0.73–1.31）、ICU住院时间（MD，–0.75天；95% CI，–3.43至1.93天）、住院时间（MD，1.03天；95% CI，–1.92至3.98天）、机械通气时间（MD，–0.10天；95% CI，–1.25至1.05天）（所有极低确定性）、心动过缓事件（RR，3.14；95% CI，0.91–14.01）和低血压事件（RR，4.74；95% CI，1.62–14.01）（所有极低确定性）的影响尚不确定。

Conclusions: 

In patients with septic shock, short-acting beta-blockers may improve survival and reduce new-onset tachyarrhythmias. However, these findings were based on low certainty evidence and given ongoing concerns regarding adverse effects and the increase duration of vasopressor use, we need larger and more rigorous RCTs to evaluate this intervention.在脓毒性休克患者中，短效β受体阻滞剂可能改善生存率并减少新发快速性心律失常。然而，这些发现基于低确定性证据，并且鉴于对不良反应和血管加压药使用时间延长的持续担忧，我们需要更大规模且更严格的RCT来评估这一干预措施。