背景:心源性休克(CS),一种复杂而危及生命的医疗状况,医院死亡率惊人,从40%到59%。经常,CS需要使用肺动脉导管(PAC)进行管理。
目的:本文献综述旨在研究与单纯无创生命体征监测相比,CS患者PAC使用率与住院30天死亡率之间的关系。
方法:从2003年1月1日至2023年8月1日进行了综合文献检索。该综述主要针对急性失代偿性心力衰竭CS患者。它比较了PAC和非PAC血流动力学监测与30天死亡率结果。五篇文章符合纳入标准,并使用CONSORT进行了质量评估,STROBE,和STARD指南。
结果:五篇文章共332794名患者。PAC患者的30天住院死亡率(22.2%至55%)低于没有PAC的患者(29.8-78%)。一项研究,然而,表明使用PAC对死亡率没有显著影响(p=0.66).值得注意的是,最低的死亡率(25%)与使用PAC完成的血流动力学分析相关.当PAC开始早期发生时,死亡率显示出更大的意义。导致死亡率进一步降低至17.3%。相反,PAC起始延迟的死亡率上升至27.7%,40%的血流动力学分析不完全,35%,不使用PAC。
结论:使用PAC降低了CS患者人群的院内死亡率,正如分析研究所建议的那样。需要通过具有标准化治疗方案和充分随访的随机对照试验(RCT)进行进一步研究以验证研究结果。
BACKGROUND: Cardiogenic shock (CS), a complex and life-threatening medical condition, has an astounding hospital mortality rate spanning from 40 % to 59 %. Frequently, CS requires the use of pulmonary artery catheters (PACs) for management.
OBJECTIVE: This literature
review aims to investigate the relationship between PAC utilization in CS patients and in-hospital 30-day mortality rates compared to noninvasive vital sign monitoring alone.
METHODS: An integrative literature search was conducted from January 1, 2003, until August 1, 2023. The
review focused on patients with acute decompensated heart failure CS. It compared PAC and non-PAC hemodynamic monitoring with 30-day mortality outcomes. Five articles met the inclusion criteria and underwent quality assessment using CONSORT, STROBE, and STARD guidelines.
RESULTS: Five articles totaled 332,794 patients. Patients with a PAC showed lower 30-day in-hospital mortality rates (22.2 % to 55 %) than patients without a PAC (29.8-78 %). One study, however, indicated that PAC use did not significantly affect mortality rates (p = 0.66). Notably, the lowest mortality rates (25 %) were linked to complete hemodynamic profiling with a PAC. The mortality rates showed greater significance when PAC initiation occurred early, resulting in a further reduction of the mortality rate to 17.3 %. Conversely, mortality rates increased to 27.7 % with delayed PAC initiation, 40 % with incomplete hemodynamic profiling, and 35 % with no PAC use.
CONCLUSIONS: PAC utilization reduces in-hospital mortality for the CS patient population, as suggested by the analyzed studies. Further research via randomized controlled trials (RCTs) with standardized treatment protocols and adequate follow-up are required to validate the findings.