多重创伤患者的皮松治疗:随机对照HYPOLYTE研究
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Antoine Roquilly1, Pierre Joachim Mahe, Philippe Seguin
1Department of Anesthesiology and Intensive Care Medicine, University of Nantes, France.
JAMA
|March 24, 2011
概括
压力剂量的皮显著降低了被直管创伤患者在医院获得的肺炎的风险. 这种治疗也减少了机械通风的持续时间和低血症的发生率.
科学领域:
- 临界护理医学 临界护理医学
- 创伤管理 创伤管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 压力剂量皮质在严重创伤管理中的作用尚不清楚.
- 对重症创伤患者的最佳治疗策略对于改善结果至关重要.
研究的目的:
- 评估静脉注射压力剂量皮在减少创伤患者在医院获得的肺炎的疗效.
- 评估皮对二次结果的影响,如机械通风持续时间,低血和死亡率.
主要方法:
- 一个多中心,随机,双盲,安慰剂对照试验 (HYPOLYTE研究) 涉及150名严重创伤患者.
- 患者接受了连续的静脉注射皮松或安慰剂7天,根据上腺反应调整治疗.
- 主要结局是28天内在医院获得的肺炎;次要结局包括通风持续时间,低血和死亡.
主要成果:
- 在治疗意图分析中,皮显著降低了49%的医院获得的肺炎发病率 (HR,0.51;P = .007).
- 接受皮的患者经历了无机械通风日数的增加 (4天,P = .001) 和低血症的减少 (P = .01).
- 在皮和安慰剂组之间没有观察到死亡率的显著差异 (8.2%对5.3%,P = .44).
结论:
- 静脉注射压力剂量的皮质有效降低了被直管创伤患者在医院获得的肺炎的风险.
- 皮治疗改善了关键的临床结果,包括减少通风时间和低血症.
- 这些发现支持使用压力剂量的皮质作为严重创伤管理中的辅助疗法.
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