心脏手术期间的细胞因子吸收与感染性内心炎 (REMOVE) 的标准手术治疗:多中心随机对照试验的结果
Mahmoud Diab1,2, Thomas Lehmann2,3, Wolfgang Bothe4
1Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.
Circulation
|February 25, 2022
概括
在感染性内心炎 (IE) 的心脏手术中,手术内血吸并没有减少器官功能障碍. 虽然它降低了炎症性细胞因子,但关键的临床结果如死亡率和通风持续时间在不同组之间保持不变.
科学领域:
- 心脏病学
- 重症监护医疗
- 外科创新
背景情况:
- 传染性内心炎 (IE) 通常需要心脏手术,这可能会引发导致器官功能障碍的炎症反应.
- 研究减轻手术后器官功能障碍的方法对于改善IE手术后患者的结果至关重要.
研究的目的:
- 评估心脏外科手术中的手术内血吸效果,以减少手术后器官功能障碍.
- 评估血液吸收对关键临床结果和炎症标志物的影响.
主要方法:
- 一个多中心,随机的,受控的试验,涉及288名因IE接受心脏手术的患者.
- 患者被分配到血液吸收组 (使用心肺绕道的CytoSorb) 或对照组.
- 主要结局是序列性器官衰竭评分 (SOFA) 的变化,次要结局包括死亡率,机械呼吸持续时间和血管压缩剂/ 置换疗法使用.
主要成果:
- 在血液吸收和对照组之间没有观察到主要结果 (ΔSOFA) 的显著差异 (1.79±3.75与1.93±3.53,P=0. 6766).
- 在两组中,30天死亡率 (21%对22%),机械呼吸持续时间和血管压缩剂或置换疗法的需要都相似.
- 在血液吸收组中检测到明显较低的互白素-1β和互白素-18水平.
结论:
- 在心脏外科手术期间的手术内血吸并没有有效地减少手术后的器官功能障碍.
- 尽管减少了特定的炎症性细胞因子,但血吸并没有改善临床相关的结果.
- 可能需要进一步的研究来确定血吸可能有益的患者子组或替代策略.
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