雾化复合组织等离子体激活剂 (rt-PA) 治疗COVID-19引起的急性呼吸衰竭:一个探索性概念验证试验
Pratima Chowdary1,2, Banwari Agarwal3, Maria Rita Peralta1,2
1Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London NW3 2QG, UK.
Journal of clinical medicine
|September 28, 2023
概括
雾化复合组织等离子体激活剂 (rt-PA) 显示出改善COVID-19患者呼吸衰竭的氧化有前途. 这项安全性研究发现rt-PA耐受性良好,具有更好的氧化趋势,特别是在非侵入性呼吸辅助患者中.
科学领域:
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- COVID-19急性肺损伤涉及扩散的气膜损伤和受损的氧化.
- 肺毛细血管血和膜纤维素沉积使COVID-19肺损伤复杂化.
- 雾化复合组织等离子体激活剂 (rt-PA) 可能提供局部血栓溶解并改善氧化.
研究的目的:
- 评估在COVID-19引起的呼吸衰竭的成年人中 nebulized rt-PA 的安全性和有效性.
- 为了确定 nebulized rt-PA. 的最佳剂量策略.
- 探索雾化rt-PA对氧化和出血事件的影响.
主要方法:
- 一项概念验证安全研究,涉及两组 (C1和C2) 患有COVID-19呼吸衰竭的成人患者.
- 患者与标准护理一起接受 nebulized rt-PA,并按通风类型分层 (侵入性机械通风或非侵入性呼吸辅助).
- 安全终点包括与治疗相关的出血和纤维素素减少;有效性是通过PaO2/FiO2 (P/F) 比率的变化来评估的.
主要成果:
- 雾化rt-PA分别给了C1的9名患者和C2的26名患者,平均时间分别为6.7天和9.1天.
- 三名患者发生了四次与治疗相关的出血 (一次严重,三次轻度);没有观察到显著的纤维素减少.
- 与历史对照相比,C1的平均P/F比率得到了更大的改善. 在C2中,非侵入性呼吸辅助患者的P/F比率改善更大,治疗日数更少.
结论:
- 雾化rt-PA似乎在COVID-19引起的呼吸衰竭患者中耐受良好.
- 观察到改善氧化的趋势,特别是在非侵入性呼吸辅助组.
- 需要进一步的随机临床试验来证实 nebulized rt-PA 的临床意义和效果的大小.
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