静脉注射氨基酸用于脏保护的随机试验
Giovanni Landoni1, Fabrizio Monaco1, Lian Kah Ti1
1From the Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute (G.L., F.M., M.B.R., A.M.S., A.F., M.G.C., G.B., A. Belletti, C.G., G.G., C.N., M.L., A.L.D.P., S.F., R. Labanca, M.M., R. Lembo, R. Losiggio, E.F., A.Z.), Vita-Salute San Raffaele University (G.L., A.Z.), and Dipartimento di Chirurgia Cardiovascolare, Unità Operativa di Anestesia e Terapia Intensiva, IRCCS Centro Cadiologico Monzino (C.B.), Milan, S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine Mauriziano Umberto I di Torino, Turin (M.C., C.V., S.P., F. Ferrod), the Department of Medical and Surgical Sciences, University Hospital "R. Dulbecco," Magna Graecia University, Catanzaro (E.G., A. Bruni, F.L.), Cardiovascular Anesthesia and ICU San Carlo Hospital, Potenza (G.P., A. Covino), Cardiac Anesthesia and ICU, AORN "Dei Colli," Monaldi Hospital, Naples (A.P., M.V.), the Department of Medicine, University of Udine (I.V., T.B.), the Division of Cardiac Surgery, Azienda Sanitaria Universitaria Friuli Centrale (I.V.), and the Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Central Friuli (T.B.), Udine, UOC Anestesia e Rianimazione, Azienda Ospedaliero Universitaria Sant'Andrea (F. Federici), and UO Complessa Anestesia e Rianimazione, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini (L.S.), Rome, the Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, and the Department of Anesthesia Analgesia Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo (A. Cortegiani), the Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (E.B., M.R.), IRCCS Humanitas Research Hospital, Anestesia e Terapia Intensiva Cardiochirurgica, Rozzano (D.K.), the Department of Anesthesia and ICU Maria Cecilia Hospital GVM Care and Research, Cotignola (L.M.), the Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genoa (S.S.), the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa (F.G.), and the Department of Anesthesia, Intensive Care and Emergency, 'Citta della Salute e della Scienza' University Hospital, Turin (R. Lobreglio) - all in Italy; the Department of Anaesthesia, National University Hospital, Singapore (L.K.T.); the Clinic of Anesthesiology, Resuscitation, and Intensive Medicine, University Hospital Dubrava, Zagreb, and University North, Department of Nursing, Varazdin - both in Croatia (N.B.); the Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan (Y.K.); and the Department of Critical Care, University of Melbourne, the Australian and New Zealand Intensive Care Research Centre, Monash University, and the Department of Intensive Care, Austin Hospital - all in Melbourne, VIC, Australia (R.B.).
静脉注射的氨基酸在心脏手术后显著降低了急性损伤 (AKI). 这种干预改善了 perfusion 和储备,为预防高风险患者的 AKI 提供了潜在的新策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 急性损伤 (AKI) 是心脏手术后的常见和严重并发症.
- 减少 perfusion 是一个主要的因素,导致 AKI 在这个患者群体.
- 静脉注射氨基酸在缓解心脏手术相关的AKI方面的潜在益处仍然不确定.
研究的目的:
- 评估静脉注射氨基酸输液在减少心脏手术的成年患者AKI发病率方面的疗效.
- 评估二次结局,包括AKI的严重程度,需要置换疗法和30天死亡率.
主要方法:
- 一个跨国,双盲,随机试验,涉及3511名计划进行心脏外科手术的成年患者.
- 患者接受了平衡的氨基酸混合物 (2g/kg/天) 或安慰剂 (林格溶液) 静脉注射,长达3天.
- AKI是由病:改善全球结果 (KDIGO) 肌素标准定义的;二次结果也被监测.
主要成果:
- 在氨基酸组 (26.9%) 与安慰剂组 (31.7%) 相比,AKI的发生率较低,相对风险为0.85 (95% CI,0.77至0.94;P=0.002).
- 第三阶段AKI在氨基酸组中发生的频率较低 (1.6%对3.0%).
- 替代疗法和30天死亡率的比率在两组之间没有显著差异.
结论:
- 静脉注射氨基酸输液有效降低了心脏手术的成年患者中AKI的发生率.
- 在心脏外科手术的背景下,氨基酸的使用可能代表了针对AKI的保护策略.
- 进一步的研究可能会探索最佳剂量和最受益的特定患者亚组.
相关概念视频
Acute Kidney Injury I: Introduction
Acute Kidney Injury II: Pathophysiology
Acute Kidney Injury III: Clinical Manifestations
Acute Kidney Injury IV: Diagnostic Studies and Prevention
Acute Kidney Injury V: Interprofessional Care
Acute Kidney Injury VI: Nursing Management


