相关实验视频
上腺素加多巴胺与单独的上腺素用于治疗败血症休克:一项随机试验
Djillali Annane1, Philippe Vignon, Alain Renault
1Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin, PRES UniverSud, Paris, France. djillali.annane@rpc.aphp.fr
Lancet (London, England)
|August 28, 2007
概括
在感染性休克管理中,单独使用上腺素的疗效和安全性与与上腺素加多巴胺相比相似. 这项大型试验发现,两种治疗策略之间的28天死亡率没有显著差异.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 国际指导方针建议在败血症休克时使用诺阿基尼林或多巴胺,而不是阿基尼林.
- 没有大型的比较试验直接评估了上腺素与上腺素加多巴胺.
研究的目的:
- 为了在患有败血性休克的患者中比较北上腺素加多巴胺与单独上腺素的疗效和安全性.
主要方法:
- 一项前性,多中心,随机,双盲研究,涉及法国19个重症监护室的330名败血症休克患者.
- 患者接受了上腺素或上腺素加上多布他胺,定位以保持平均血压≥70毫米升.
- 主要结局是28天全因死亡率;进行了治疗意向分析.
主要成果:
- 在28天全因死亡率上没有显著差异:上腺素组的40%,与上腺素加多巴胺组的34%相比 (p=0.31).
- 在重症监护室出院,医院出院和90日之间,死亡率在各组之间相似.
- 在血液动力学成功,血管压缩剂取消或SOFA得分进展的时间内没有观察到显著差异;严重的不良事件也相似.
结论:
- 单独的上腺素和诺拉上腺素加多布他胺在治疗败血症休克时表现出相似的疗效和安全性.
- 这项研究没有提供证据来支持一种治疗策略,而不是另一种治疗策略,以对感染性休克进行管理.
相关概念视频
Cardiopulmonary Resuscitation IV: Pharmacological Management
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Adrenergic Agonists: Therapeutic Uses
Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
Adrenergic Agonists: Mixed-Action Agents
Mixed-action adrenergic agonists, like ephedrine and pseudoephedrine, directly and indirectly affect adrenergic receptors. These agents stimulate adrenoceptors and indirectly release stored neurotransmitters, amplifying the adrenergic response.
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
Depolarizing Blockers: Pharmocokinetics
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Adrenergic Agonists: Direct-Acting Agents
Drugs that mimic the action of endogenous catecholamines like noradrenaline and adrenaline are called adrenergic agonists or sympathomimetics. Based on their mechanism of action, sympathomimetics can be classified as direct-, indirect-, or mixed-acting sympathomimetics. Direct-acting adrenergic agonists activate adrenoceptors without affecting presynaptic neurons, making them independent of neuronal catecholamine-depleting agents like reserpine and guanethidine.
These agents can be classified...
These agents can be classified...