背景:已经研究了β受体阻滞剂在危重病中的作用,在过去的二十年中,有关这些药物对危重病人的保护作用的数据已在文献中反复报道。然而,在危重患者中使用β受体阻滞剂的问题上,科学团体仍缺乏共识和指南.本文件的目的是支持危重患者使用β受体阻滞剂的临床决策过程。这份文件的接受者是医生,护士,医护人员,以及其他参与患者护理过程的专业人员。
方法:意大利麻醉学会,镇痛,复苏和重症监护(SIAARTI)选择了一个专家小组,并要求他们定义在危重成年患者中使用β受体阻滞剂的关键方面。专家在此过程中遵循的方法符合改良的Delphi和RAND-UCLA方法的原则。专家们以翔实的文字形式提出了声明和支持性理由。发言的总体清单遭到盲目投票以达成共识。
结果:文献检索表明,危重患者的肾上腺素能应激和心率增加与器官功能障碍和死亡率增加有关。因此,心率控制在危重病人的管理中似乎至关重要。需要针对继发性心动过速的鉴别诊断和节律紊乱的治疗进行仔细的临床评估。此外,在排除低血容量后,脓毒性休克患者可考虑使用β受体阻滞剂治疗持续性心动过速.静脉给药应该是首选的给药途径。
结论:β受体阻滞剂对危重患者的保护作用已在文献中反复报道。它们在心率加快的急性治疗中的使用需要了解病理生理学和仔细的鉴别诊断。因为心动过速的所有原因都应该首先排除和解决。
BACKGROUND: The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However,
consensus and
guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking. The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient\'s care process.
METHODS: The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for
consensus.
RESULTS: The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration.
CONCLUSIONS: β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first.