肌内上腺素对胰岛素诱导的低血压的影响:一个随机的安慰剂控制的试验试验
Matthias Weiss-Tessbach1, Al Medina Dizdarevic1, Thorsten Bischof1
1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
肌内上腺素 (上腺素) 注射在健康志愿者中没有有效地逆转组胺诱导的低血压. 这项研究质疑其作为第一线治疗过敏性休克的既定作用.
科学领域:
- 过敏反应和紧急医疗
- 药理学和治疗学 药理学和治疗学
- 临床试验设计 临床试验设计
背景情况:
- 肌内上腺素是对过敏反应的基于共识的第一线治疗方法.
- 它在逆转胰岛素诱导的低血压方面的有效性,这是过敏性休克的关键特征,尚未被随机对照试验证明.
- 在人类中,低血压和休克与血组胺水平相关.
研究的目的:
- 评估肌内上腺素在逆转基因组胺诱导的低血压和健康志愿者的冲击中的疗效.
- 提供关于关键过敏反应治疗有效性的证据.
主要方法:
- 进行了一项探索性开放标签和一项确认性随机,双盲,安慰剂控制的交叉试验.
- 健康的志愿者接受了静脉注射的组胺注射,以诱导低血压.
- 肌肉内注射上腺素或安慰剂,如果平均动脉压 (MAP) 保持在60mmHg以下,则给予第二剂.
主要成果:
- 肌内上腺素未能产生显著的压力反应,并且在很大程度上与安慰剂无法区分.
- 只有25%的参与者在一次性上腺素剂量后出现过渡性MAP恢复.
- 第二剂上腺素也未能在大多数参与者中逆转低血压.
结论:
- 肌内上腺素注射在大多数健康受试者中没有产生持续的压力反应,这些受试者经历了严重的基因组胺介导的低血压.
- 这些发现表明,需要重新评估支持肌内上腺素作为过敏反应的第一线治疗的证据.
- 需要进一步的研究,以在更广泛的人群中证实这些发现.
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