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首页> 外文期刊>Current opinion in anaesthesiology >Do corticosteroids improve outcome for any critical illness?
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Do corticosteroids improve outcome for any critical illness?

机译：皮质类固醇能改善任何重大疾病的预后吗？

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Purpose of Review: Corticosteroids have been widely administered in critically ill patients for various indications. Their clinical benefit is broadly investigated but remains controversial. The purpose of this review is to explore the use of corticosteroids in intensive care, their impact on patient outcome and to provide practical guidance for the use of corticosteroids in the ICU. Recent Findings: Critical illness is the result of significant tissue damage, due to cellular ischemia, trauma or infection, inducing a systemic inflammatory syndrome. Recent advances in the understanding of the immunologic and molecular mechanisms of inflammation support, in part, the conceptual use of corticosteroids as an adjunct immunomodulatory therapy. But use of corticosteroids carries the risk of severe adverse effects, partly because of their anti-infammatory effects. Recently, clinical research has focused on critical illness-related corticosteroid insufficiency and several trials investigated the role of corticosteroids therapy in septic and critically ill patients with severe systemic inflammation such as acute respiratory distress syndrome, severe community-acquired pneumonia and meningitis. Improved morbidity has been demonstrated in some studies but a clear benefit in term of mortality was not observed. Summary: Critical illnesses stem from a group of heterogeneous medical conditions. Failure to target subgroups more likely to benefit from the use of corticosteroids may be one explanation for the largely disappointing results in clinical trials, thus, far. ? 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
机译：审查目的：皮质类固醇已被广泛用于危重患者的各种适应症。他们的临床益处得到广泛研究，但仍存在争议。这篇综述的目的是探讨皮质类固醇在重症监护中的使用及其对患者预后的影响，并为在ICU中使用皮质类固醇提供实用指导。最新发现：严重疾病是由于细胞局部缺血，创伤或感染引起的严重组织损伤的结果，诱发全身性炎症综合征。炎症支持的免疫学和分子机制的理解方面的最新进展，部分是皮质类固醇作为辅助免疫调节疗法的概念性应用。但是，使用皮质类固醇会带来严重不良反应的风险，部分原因是因为它们具有消炎作用。最近，临床研究集中在与严重疾病有关的皮质类固醇激素不足，并且一些试验研究了皮质类固醇激素在脓毒症和危重病患者中的作用，这些患者患有严重的全身性炎症，例如急性呼吸窘迫综合征，严重的社区获得性肺炎和脑膜炎。在一些研究中已证明发病率有所改善，但未观察到死亡率方面的明显益处。摘要：重大疾病源于一组不同的医学状况。到目前为止，未能针对更可能受益于使用皮质类固醇激素的亚人群可能是造成临床试验结果令人失望的一种解释。 ？ 2013威科集团健康|利平科特·威廉姆斯和威尔金斯。

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