在休克中直接评估微循环:一个随机对照的多中心研究
Raphael Romano Bruno1, Jakob Wollborn2, Karl Fengler3
1Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
Intensive care medicine
|June 6, 2023
概括
这项研究发现,在冲击管理中使用语言下微循环 perfusion 变量并没有降低 30 天死亡率. 虽然它导致了更多的治疗调整,但患者的生存率保持不变.
科学领域:
- 关键护理医学 关键护理医学
- 心血管研究研究心血管研究
- 医疗技术 医疗技术 医学技术
背景情况:
- 冲击是一种关键性疾病,涉及微循环功能障碍.
- 早期识别和管理微循环变化对于患者的治疗结果至关重要.
研究的目的:
- 测试将语言下微循环 perfusion 变量整合到治疗管理中是否会降低重症监护室 (ICU) 休克患者的 30 天死亡率.
- 评估微循环引导治疗对患者存活率和其他临床结果的影响.
主要方法:
- 一个随机的,前性的,多中心临床试验,涉及141名ICU患者.
- 在ICU入院和24小时后,使用侧流暗场 (SDF) 显微镜评估了舌下微循环.
- 患者被随机分配到以微循环变量为指导的常规护理或治疗.
主要成果:
- 干预组对血管活性药物或液体的调整显著增加 (66.7%对41.8%,p=0.009).
- 干预和常规护理组之间30天死亡率没有显著差异 (47.1%对34.7%,HR 1.54,p=0.118).
- 像ICU和住院长度和6个月死亡率这样的二次终点没有显著差异.
结论:
- 将舌下微循环输液变量纳入冲击管理导致治疗修改,但没有改善30天生存率.
- 目前的证据不支持常规使用语言下微循环监测来提高休克患者的死亡率结果.
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