推迟动脉导管治疗的危急病患者与冲击
Grégoire Muller1,2, Damien Contou3, Stephan Ehrmann4
1Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
The New England journal of medicine
|October 29, 2025
概括
在休克患者中,非侵入性血压监测与早期动脉导管治疗一样有效,显示了类似的28天死亡率. 这种方法减少了侵入性手术和相关并发症.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 临床试验 临床试验
背景情况:
- 关于非侵入性血压监测与动脉导管在休克患者中的有效性存在不确定性.
- 尽管存在潜在风险,但动脉导管是推的标准,用于在休克状态下监测血压.
研究的目的:
- 为了确定非侵入性血压监测是否不劣于早期的动脉导管插入,震惊患者.
- 为了在休克患者中比较侵入性和非侵入性血压监测策略之间的28天死亡率.
主要方法:
- 一个多中心的,开放的,非劣势性试验随机将1010名休克患者随机分配到早期的动脉导管 (侵入性) 或自动臂袖 (非侵入性) 监测中.
- 如果符合安全标准,非侵入性组的患者可以在以后接受动脉导管.
- 主要结局是28天的所有原因导致的死亡,非劣势率为5个百分点.
主要成果:
- 28天死亡率在非侵入性组为34.3%,在侵入性组为36.9% (调整后的风险差异: -3.2%;P=0.006对于非劣势).
- 动脉导管插入发生在非侵入性组的14.7%,入侵性组的98.2%.
- 在非侵入性组中报告了13.1%的疼痛或不适感,而在侵入性组中为9.0%;导管相关的血瘤/出血发生在1.0%和8.2%之间.
结论:
- 没有早期插入动脉导管的休克患者的治疗与早期导管治疗相比,在28天死亡率方面没有劣势.
- 非侵入性监测策略似乎是安全和有效的,可能减少侵入性手术相关的并发症和患者的不适.
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