Emerging concepts in the care of patients with cirrhosis and septic shock.
Emerging concepts in the care of patients with cirrhosis and septic shock.
复制标题
肝硬化和败血性休克患者护理中的新兴概念。
DOI：
10.4254/wjh.v15.i4.497
复制
发表时间：
2023-04-27
影响因子：
2.4
通讯作者：
Saffo S
中科院分区：
文献类型：
--
作者：
Jimenez JV;Garcia-Tsao G;Saffo S
感染性休克影响约6%的肝硬化住院患者，并与高发病率和死亡率相关。尽管一些具有里程碑意义的临床试验为普通人群中感染性休克的诊断和管理的逐步改善铺平了道路，但肝硬化患者在很大程度上被排除在这些研究之外，关键的知识差距继续影响这些人的护理。在这篇综述中，我们讨论了肝硬化和感染性休克患者的护理中的细微差别，使用病理生理学为基础的方法。我们说明，感染性休克可能是具有挑战性的诊断在这一人群的背景下，如慢性低血压，乳酸代谢受损，并伴随肝性脑病的因素。此外，我们证明，常规干预措施，如静脉输液，血管加压药，抗生素和类固醇的应用，应仔细考虑那些失代偿期肝硬化的血流动力学，代谢，激素和免疫紊乱。我们建议，未来的研究应该包括和肝硬化患者的特点，在系统的方式，临床实践指南可能需要相应地完善。
Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.
登录
查看更多内容
DOI：
10.1097/meg.0000000000001826
发表时间：
2021-09-01
影响因子：
2.1
作者：
Cheng CY;Kung CT;Wu KH;Chen FC;Cheng HH;Cheng FJ;Huang JB;Su CM
通讯作者：
Su CM
DOI：
10.1186/cc13868
发表时间：
2014-05-12
期刊：
Critical care (London, England)
影响因子：
--
作者：
Beck V;Chateau D;Bryson GL;Pisipati A;Zanotti S;Parrillo JE;Kumar A;Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
通讯作者：
Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
影响因子：
120.7
作者：
Annane, Djillali;Siami, Shidasp;Chevret, Sylvie
通讯作者：
Chevret, Sylvie
影响因子：
120.7
作者：
Annane, D;Sébille, V;Bellissant, E
通讯作者：
Bellissant, E
影响因子：
3
作者：
Canus, B. Suberviola;Jauregui, R.;Castellanos-Ortega, A.
通讯作者：
Castellanos-Ortega, A.