JAMA:早期使用低剂量氢化可的松对早产儿的神经发育有益处么?

2017-04-07 MedSci MedSci原创

地塞米松用于防止早产新生儿的支气管肺发育不良与不良神经发育事件有关。据报道,早期使用低剂量氢化可的松治疗可以改善生存期,无支气管肺发育不良,但是其对神经发育的安全性尚待评估。近期,一项发表在权威杂志JAMA上的研究评估了早产儿早期使用氢化可的松治疗是否与2岁以上的神经发育障碍相关。此项研究为PREMILOC(早期低剂量氢化可的松改善无支气管肺发育不良早产儿的生存率)的随机临床试验,于2008年至2

地塞米松用于防止早产新生儿的支气管肺发育不良与不良神经发育事件有关。据报道,早期使用低剂量氢化可的松治疗可以改善生存期,无支气管肺发育不良,但是其对神经发育的安全性尚待评估。

近期,一项发表在权威杂志JAMA上的研究评估了早产儿早期使用氢化可的松治疗是否与2岁以上的神经发育障碍相关。

此项研究为PREMILOC(早期低剂量氢化可的松改善无支气管肺发育不良早产儿的生存率)的随机临床试验,于2008年至2014年在法国21个新生儿重症监护病房中进行。根据孕龄组分层进行随机分组。2010年至2016年完成神经发育评估。

出生后,患儿被随机分配为接受安慰剂或氢化可的松(0.5 mg / kg,每天两次,共7天,随后是每天0.5 mg / kg,持续3天)治疗。

神经发育障碍预先的指导探索性结果基于标准化神经学检查和修订的Brunet-Lézine量表(全球发育商评分和分数;平均值,100 [SD,15])。全球发育商的最小临床重要差异为5分。

此项研究结果显示:筛选的1072例新生儿中,共523例被分配到氢化可的松组(n = 256)或安慰剂组(n = 267),其中406例存活至2岁。在22个月的中位修正年龄中(四分之一范围,21-23个月),共评估了379名患者(93%; 46%的女性)(氢化可的松组194人,安慰剂组185人)。

没有神经发育障碍的患者分布(73%在氢化可的松组,而安慰剂组为70%),轻度神经发育障碍(氢化可的松组为20%,安慰剂组为18%)或中度至重度神经发育障碍(氢化可的松组为7%,安慰剂组为11%)的组间差异无统计学意义(P = 0.33)。

平均全球发育商评分在组间差异无统计学意义(氢化可的松组91.7,安慰剂组为91.4;组间差异为0.3 [95%CI,-2.7〜3.4]; P = 0.83)。脑瘫或其他主要神经功能障碍的发生率在组间无明显差异。

此项研究结果表明:在对早产儿随机临床试验的次要结果的探索性分析中,早期予以低剂量氢化可的松与2岁时神经发育之间的关系无统计学显着性意义。

原始出处:
Baud O, Trousson C, Biran V, et al. Association Between Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years of Age. JAMA. 2017 Apr 4;317(13):1329-1337. doi: 10.1001/jama.2017.2692.

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    2017-04-08 jin321

    这研究难搞

    0

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    2017-04-08 1e10c84am36(暂无匿称)

    文章不错,值得分享

    0

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    2017-04-07 knowheart

    无统计学显着性意义

    0

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背景:继发性肾上腺皮质功能不全(SAI)患者心血管风险的增加,可能归因于随之相对高剂量氢化可的松替代的不利的代谢影响。目的:探究较高的和较低的糖皮质激素替代治疗剂量对血压(BP)、肾素-血管紧张素-醛固酮系统(RAAS)、11β-羟类固醇脱氢酶(11βHSD)酶活性和(去甲)肾上腺素循环的影响。方法:格罗宁根大学医疗中心的47名患者参加了这项随机双盲交叉研究。患者随机接受0.2-0.3毫克/公斤体

JAMA:一直以来建议的氢化可的松预防脓毒性休克,真的有效吗?

拯救脓毒症运动建议难治性感染性休克患者可使用辅助性氢化可的松治疗。但目前氢化可的松在严重脓毒症无休克患者中的疗效仍有争议。来自德国的研究人员开展了一项研究,该研究旨在确定在严重脓毒症患者中,氢化可的松治疗是否能够预防脓毒性休克的发展。该双盲,随机临床试验于2009年1月13日至2013年8月27日期间进行,随访期为180天,直至2014年2月23日。该试验在德国的34家大学和社区医院的中级或重症监

Ann Surg:围手术期使用氢化可的松,能减少胰十二指肠切除术后并发症

本研究的目的是探讨,氢化可的松是否可以减少高危患者的胰十二指肠切除术后并发症(PPDC)。软胰腺是一个知名的PPDC的风险因素。此前,我们已经表明,胰腺横断线> 40%腺泡的患者最容易发展为PPDC。最近的研究表明,手术创伤导致残留胰腺的炎症,会促进PPDC的发生。在动力分析的基础上,随机对照试验(RCT)(NCT01460615),纳入155例(2012年2月至2015年3月)拟行胰十二指

Lancet:低剂量氢化可的松可预防极早产儿的支气管肺发育不良

支气管肺发育不良,是极早产的主要并发症,治疗选择很少。产后类固醇的使用是有争议的,但低剂量的氢化可的松可以防止炎症对肺发育的有害影响。在这项研究中,该研究的目的是评估低剂量氢化可的松是否提高无支气管肺发育不良极早产儿的生存率。这项双盲,安慰剂对照的随机试验在21个法国三级护理新生儿重症监护病房(NICUs)进行,研究人员通过一个安全的研究网站随机分配(1:1)极度早产的婴儿(出生在和NICU一样的

JAMA:氢化可的松能预防脓毒症患者感染性休克的发展吗?

辅助氢化可的松治疗无休克的严重脓毒症患者,疗效如何?本研究的目的是,评估氢化可的松治疗能否预防严重脓毒症患者感染性休克的发展。本项双盲、随机临床试验时间为2009年1月13日-2013年8月27日,随访180天,直到2014年2月23日。包括380名成人重度脓毒症患者,没有感染性休克。患者按1:1被随机分配为持续输注氢化可的松200毫克,5天之后,剂量逐渐减少直到11天(n = 190)或安慰剂(