适度和严重急性呼吸困扰综合征患者的倾斜定位:一个随机对照试验
Paolo Taccone1, Antonio Pesenti, Roberto Latini
1Dipartimento di Anestesia e Rianimazione, Fondazione IRCCS-Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, 20122 Milan, Italy.
JAMA
|November 12, 2009
概括
在中度或重度急性呼吸窘迫综合征 (ARDS) 患者中,躺卧并没有改善生存率. 这项随机试验没有发现易患组28天或6个月死亡率的显著益处.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统医学 呼吸系统医学
- 临床试验 临床试验
背景情况:
- 之前的分析表明,倾斜的位置可能会提高严重急性呼吸困扰综合征 (ARDS) 患有低氧症的患者的生存率.
- 倾斜体II研究旨在在更广泛的ARDS人群中验证这些发现.
- 了解最佳通风策略对于改善ARDS的结果至关重要.
研究的目的:
- 评估倾斜定位在改善ARDS患者中度和重度低氧化血症的生存结果中的有效性.
- 评估倾斜定位对机械通风ARDS患者死亡率和其他临床结果的影响.
主要方法:
- 一个多中心,无盲,随机对照试验 (Prone-Supine II研究) 涉及342名成年ARDS患者.
- 患者被分为中度 (n=192) 和严重 (n=150) 低氧症亚组.
- 在机械通风期间,参与者被随机分配到躺着的位置或倾斜的位置 (每天20小时).
主要成果:
- 总的来说,倾斜的定位与卧卧的定位相比,没有显著降低28天或6个月的全因死亡率 (31.0%与28天的32.8%相比).
- 在小组分析中,倾向性定位在28天或6个月后对中度低氧血症患者没有显著的生存益处.
- 同样,对于患有严重低氧血症的患者来说,倾斜的位置并没有导致28天或6个月死亡率的统计学上显著降低.
结论:
- 每天躺下20小时,在中度或重度低氧血症的ARDS患者中没有显著的生存优势.
- 该研究没有发现证据支持常规使用易感定位来改善这种患者群体的死亡率.
- 倾斜定位组观察到更高的并发症率,没有相应的生存益处.
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