硫酸用于治疗严重的破伤风:一个随机对照试验
C L Thwaites1, L M Yen, H T Loan
1Oxford University Clinical Research Unit, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK. louise.thwaites@btinternet.com
Lancet (London, England)
|October 24, 2006
概括
持续输注硫酸给严重患者并没有减少机械通风的需要. 然而,它显著降低了对肌肉松剂和药物管理自主不稳定的需求.
科学领域:
- 关键护理医学 关键护理医学
- 神经学 神经学
- 传染性疾病 传染性疾病
背景情况:
- 严重的破伤风带来了由于呼吸衰竭或自主功能障碍而导致的显著死亡风险.
- 呼吸衰竭通常需要机械通风,而自主性不稳定性在通风患者中存在风险.
- 有效地管理肌肉和自主性不稳定性对于改善严重破伤风的结果至关重要.
研究的目的:
- 评估连续输注硫酸的疗效,以减少在严重结石风的机械通风的需要.
- 评估硫酸对控制肌肉和自主性不稳定性的影响.
- 为了确定硫酸是否能改善严重病患者的生存率.
主要方法:
- 一项随机,双盲,安慰剂对照试验与256名严重破伤风的成年患者进行.
- 参与者接受了静脉注射硫酸或安慰剂7天.
- 主要结局包括需要辅助呼吸和治疗和心血管不稳定的药物.
主要成果:
- 与安慰剂相比,硫酸并没有显著减少机械通风的需要 (OR 0.71,p=0.324).
- 接受硫酸治疗的患者需要显著减少米达佐拉姆 (p=0.026) 和pipecuronium (p=0.005) 来控制.
- 硫酸治疗导致因心血管不稳定而需要维拉帕米尔的可能性减少了4.7倍.
结论:
- 连续输注硫酸并不能有效降低在严重结石风的机械通风的需要.
- 硫酸显著降低了对辅助药物的需求,以管理严重的肌肉和心血管不稳定性.
- 虽然不影响通风需求,但硫酸在治疗严重结症的关键并发症方面具有好处.
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