在急性酸中毒中使用胰岛素-高血糖治疗:一项随机临床试验
Basma Adel1, Nashwa Mohamed Elgharbawy2, Marwa Mohamed Shahin1
1Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt.
Clinical toxicology (Philadelphia, Pa.)
|December 14, 2023
概括
这项研究发现,胰岛素-高血糖治疗显著降低了酸中毒患者的死亡率. 与标准护理相比,这种治疗改善了血压,减少了血管压缩器和输管治疗的需要.
科学领域:
- 毒理学 毒理学 毒理学
- 紧急医疗 紧急医疗
- 心血管医学 心血管医学
背景情况:
- 化 (AlP) 中毒是导致死亡的重要原因,特别是在发展中国家.
- 目前还没有确立的对AlP中毒的解药,导致高死亡率.
- 标准治疗通常涉及支持性护理和血管压缩剂,但成功程度有限.
研究的目的:
- 评估胰岛素-高血糖治疗在治疗急性酸中毒中的安全性和有效性.
- 为了比较接受胰岛素高血糖治疗加标准治疗的患者和接受安慰剂标准治疗的患者之间的结果.
主要方法:
- 一项前性随机试验,涉及108名急性化中毒患者.
- 患者被分配到胰岛素-高血糖治疗与标准治疗 (上腺素,支持性护理) 或标准治疗与安慰剂.
- 主要结局措施包括生存率,血压和实验室参数.
主要成果:
- 与对照组 (96.3%) (P <0.001) 相比,胰岛素高血糖治疗与明显较低的死亡率 (64.8%) 相关.
- 接受胰岛素高血糖症的患者需要较低的血管压缩剂剂量 (中位数为7毫克而不是26毫克) 和较少的输管治疗 (61.1%而不是81.5%).
- 随着胰岛素-高血糖治疗,血压 (静脉缩,腹缩,平均动脉压) 的显著改善和二碳酸盐和乳酸盐水平的正常化被观察到.
结论:
- 胰岛素euglycemia治疗显示出作为急性酸中毒的安全和有效治疗的潜力.
- 标准的纯血管压缩剂治疗与ALP中毒的极其糟糕的结果有关.
- 进一步的研究可能会支持将胰岛素-高血糖症纳入AlP中毒的管理方案.
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