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乳酸清除与中静脉氧和作为早期败血症治疗的目标:一个随机临床试验
Alan E Jones1, Nathan I Shapiro, Stephen Trzeciak
1Department of Emergency Medicine, 1000 Blythe Blvd, Carolinas Medical Center, Charlotte, NC 28203, USA.
JAMA
|February 25, 2010
概括
乳酸清除和中央静脉氧和 (ScvO2) 在早期败血症复苏中表现出类似的有效性,两种方法在医院死亡率上没有显著差异.
科学领域:
- 临界护理医学 临界护理医学
- 紧急医疗 紧急医疗
- 败血症病理生理学
背景情况:
- 针对严重败血症和败血症休克的目标导向复苏可以减少急诊室的死亡率.
- 早期败血症复苏方案的目的是改善患者的治疗结果.
研究的目的:
- 为了比较乳酸清除与中静脉氧和 (ScvO2) 的非劣质性,作为早期败血症复苏的目标.
- 评估这些复苏策略对住院死亡率的影响.
主要方法:
- 一个多中心随机的非劣势性试验涉及300名患有严重败血症或败血性休克的患者.
- 患者被分配到针对ScvO2 (≥70%) 或乳酸清除 (≥10%) 的复苏方案,以及血液动力学目标.
- 主要结局是住院死亡率,乳酸清除的非劣势值为-10%.
主要成果:
- 在ScvO2组的住院死亡率为23%,在乳酸清除组为17%.
- 观察到的死亡率差异没有达到预定义的非劣势值.
- 两种复苏策略之间没有发现不良事件的显著差异.
结论:
- 在感染性休克患者中,正常化乳酸清除在降低住院死亡率方面与正常化ScvO2相比没有显著差异,当血液动力学参数也得到控制时.
- 乳酸清除和ScvO2引导的复苏似乎都是早期败血症管理的可行选择.
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