重症患者の組織酸素化の治療指数としての胃内膜内 pH
G Gutierrez1, F Palizas, G Doglio
1Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston 77030.
Lancet (London, England)
|January 25, 1992
まとめ
ガストリック・イントラムコサル pH (pHi) モニタリングによるガイドセラピーは,初期pHiが正常であった重症病棟 (ICU) の患者の生存率を向上させた. このアプローチは,臓器低酸素症を予防し,患者のアウトカムを改善することができます.
科学分野:
- クリティカルケア・メディシン
- 胃腸内科 胃腸内科
- 生理学 生理学とは
背景:
- 胃内膜内pH (pHi) の低下は,集中治療室 (ICU) の患者の罹病率と死亡率の増加と相関しています.
- 適切なスプランク性輸液の維持は,ICU患者のアウトカムにとって極めて重要です.
研究 の 目的:
- 集中治療室 (ICU) のアウトカムが,胃内内pH (pHi) の変化によって導かれた治療によって改善できるかどうかをテストする.
- pHi誘導療法による全身酸素供給の最適化により,患者の生存率が向上するかどうかを評価する.
主な方法:
- APACHE IIスコア15〜25.のICU患者260人を対象としたランダム化比較試験.
- 患者は標準治療または,pHiが7.35以下になったときに酸素輸送を改善するまたは需要を減らすための治療を受けるプロトコルグループに割り当てられました.
- 胃トノメーターは,継続的なpHiモニタリングと評価に使用されます.
主要な成果:
- 低pHiで入院した患者の生存率は,プロトコルと対照群 (37%対36%) の間で類似していました.
- 正常なpHiで入院した患者は,対照群と比較してプロトコル群で生存率が有意に改善した (58%対42%; p <0.01).
- pHiガイドセラピープロトコルは,pHiの低下を経験したプロトコルグループの患者の85%で開始されました.
結論:
- 胃内内pH (pHi) 測定による治療は,正常な入院pHiのICU患者の生存率を大幅に改善しました.
- pHi誘導蘇生は,スプランク臓器低酸素症と全身的な酸素不足を予防することによって,結果を向上させる可能性があります.
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