低剂量多巴胺或低剂量内西里在急性心力衰竭和功能障碍中:ROSE急性心力衰竭随机试验
Horng H Chen1, Kevin J Anstrom2, Michael M Givertz3
1Mayo Clinic, Rochester, Minnesota.
JAMA
|November 20, 2013
概括
在急性心力衰竭和功能障碍的患者中,低剂量多巴胺和内西里蒂德并没有改善脱血或功能,当它们被添加到利尿剂治疗中时. 这些发现表明,这些低剂量药物不会增强当前的策略.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有功能障碍的急性心力衰竭 (AHF) 是一个重大的临床挑战.
- 之前的小型研究表明,低剂量多巴胺或内西里提德对AHF的脱血和功能有潜在的益处.
- 然而,这些策略缺乏严格的临床验证.
研究的目的:
- 评估低剂量多巴胺和低剂量内西里蒂德在增强脱血和维护功能方面在患有功能障碍的AHF患者中的有效性.
- 测试独立的假设,这些药物,当添加到利尿药治疗,将改善临床结果与安慰剂相比.
主要方法:
- 一个多中心,双盲,安慰剂对照试验 (ROSE) 涉及360名住院患者的AHF和功能障碍 (eGFR15-60毫升/分钟/1.73米2).
- 患者被随机分配,接受低剂量多巴胺 (2μg/kg/min) 或低剂量内西里提德 (0.005μg/kg/min) 加上利尿剂,或安慰剂加上利尿剂.
- 共同初级终点是72小时累积的尿量和从入学到72小时的血清囊素C的变化.
主要成果:
- 低剂量多巴胺与安慰剂相比,在72小时尿量 (229毫升的差异;P=.59) 或囊C的变化 (0.01的差异;P=.72) 中没有显著差异.
- 低剂量内西里提德也没有显著影响72小时尿量 (279毫升的差异;P=.49) 或囊C的变化 (-0.04的差异;P=.36).
- 两种药物都没有影响与脱血,功能或临床结果相关的二次终点.
结论:
- 在患有AHF和功能障碍的患者中,添加低剂量的多巴胺或低剂量的内西里提德添加到利尿剂治疗中,并没有增强脱血或改善功能.
- 这些发现不支持使用这些低剂量药物作为利尿剂的辅助剂,以改善该患者群体的治疗结果.
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