糖尿病患者围手术期使用地塞米松:随机安慰剂对照试验的系统回顾和元分析》。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-09-01 Epub Date: 2024-08-16 DOI:10.1213/ANE.0000000000007007
Ian A Jones, Michael A LoBasso, Julian Wier, Brandon S Gettleman, Mary K Richardson, Christina E Ratto, Jay R Lieberman, Nathanael D Heckmann
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引用次数: 0

摘要

背景:由于对感染和不良事件的担忧,糖尿病患者围手术期使用地塞米松仍存在争议。本研究旨在确定临床证据是否支持糖尿病患者因担心感染风险而暂停使用地塞米松。我们假设地塞米松治疗患者与对照组的感染结果没有差异:方法:我们于 2022 年 11 月 22 日进行了一次文献检索,以确定研究短疗程地塞米松的随机安慰剂对照试验:结果:共纳入16项研究,其中5项进行了定量分析。在 2592 名糖尿病患者中,有 2344 人(1184 人随机接受地塞米松治疗,1160 人接受安慰剂治疗)至少接受了一项定量分析。定量分析显示,围手术期使用地塞米松对手术部位感染的风险没有影响(对数比[LOR],-0.10,95%;95% 置信区间[CI],-0.64 至 0.44),但却显著降低了综合不良事件的风险(对数比,-0.33;95% 置信区间,-0.62 至 -0.05)。定性分析证实了这些研究结果,在所有临床结果中均显示出非劣效到优效的结果。所纳入的研究之间存在高度异质性:目前的证据表明,糖尿病患者围手术期使用地塞米松不会增加感染并发症的风险。需要进行前瞻性研究,以优化剂量、频率和时间,并明确研究地塞米松在糖尿病控制不佳患者中的应用。
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Perioperative Dexamethasone in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials.

Background: The perioperative use of dexamethasone in diabetic patients remains controversial due to concerns related to infection and adverse events. This study aimed to determine whether clinical evidence supports withholding dexamethasone in diabetic patients due to concern for infection risk. We hypothesized that there is no difference in infectious outcomes between dexamethasone-treated patients and controls.

Methods: A literature search was performed on November 22, 2022 to identify randomized, placebo-controlled trials investigating short-course (<72 hours), perioperative dexamethasone that explicitly included diabetic patients and measured at least 1 clinical outcome. Pertinent studies were independently searched in PubMed, Embase, and Cochrane. Authors for all identified studies were contacted with the aim of performing quantitative subgroup analyses of diabetic patients. The primary end point was surgical site infection and the secondary end point was a composite of adverse events. Qualitative remarks were reported based on the total available data and a quality assessment tool. Meta-analyses were performed using inverse variance with random effects. Heterogeneity was assessed via standard χ2 and I2 tests.

Results: Sixteen unique studies were included, 5 of which were analyzed quantitatively. Of the 2592 diabetic patients, 2344 (1184 randomized to dexamethasone and 1160 to placebo) were analyzed in at least 1 quantitative outcome. Quantitative analysis showed that the use of perioperative dexamethasone had no effect on the risk of surgical site infections (log odds ratio [LOR], -0.10, 95%; 95% confidence interval [CI], -0.64 to 0.44) while significantly reducing the risk of composite adverse events (LOR, -0.33; 95% CI, -0.62 to -0.05). Qualitative analysis reinforced these findings, demonstrating noninferior to superior results across all clinical outcomes. There was high heterogeneity between the included studies.

Conclusions: Current evidence suggests perioperative dexamethasone may be given to diabetic patients without increasing the risk of infectious complications. Prospective investigations aimed at optimizing dose, frequency, and timing are needed, as well as studies aimed explicitly at exploring the use of dexamethasone in patients with poorly controlled diabetes.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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