在严重细菌性脑膜炎中引起的低温:一项随机临床试验
Bruno Mourvillier1, Florence Tubach, Diederik van de Beek
1Réanimation Médicale et Infectieuse, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude Bernard, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
JAMA
|October 10, 2013
概括
诱导性低温并没有改善严重细菌性脑膜炎患者的结果,可能会增加死亡率. 进一步的安全评估对于未来在重症监护机构的低温试验至关重要.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
背景情况:
- 急性细菌性脑膜炎,特别是肺炎球菌性脑膜炎,尽管治疗方面取得了进展,但死亡率和发病率很高.
- 诱导性低温已在涉及全球脑缺氧的条件中显示出好处.
研究的目的:
- 评估诱导性低温是否能改善昏迷状态的成年人患有严重细菌性脑膜炎的结果.
主要方法:
- 一个多中心的,开放的,随机的临床试验,涉及98名昏迷的细菌性脑膜炎患者.
- 患者在48小时内冷却至32-34°C (低温组) 或接受标准护理 (对照组).
- 主要结局是格拉斯哥结局尺度3个月的得分;由于安全问题,该试验被提前停止.
主要成果:
- 由于低温组的死亡率 (51%) 与对照组 (31%) 相比显著更高,该试验被提前终止.
- 在低温组中,3个月的不良结果也更高 (86%vs. 74%),尽管在统计学上并不显著.
- 后期分析表明,证明低温的益处是徒劳的可能性很高.
结论:
- 中度低温并没有改善严重细菌性脑膜炎的结果,并且可能是有害的.
- 未来研究低温的试验需要仔细评估安全性,特别是对于感染性休克或中风患者.
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