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NEJM：急性呼吸窘迫综合征患者自由氧疗或保守氧疗比较

2020-03-12 MedSci原创 MedSci原创

急性呼吸窘迫综合征,自由氧疗,保守氧疗
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由此可见，在ARDS患者中，早期维持Pao2在55~70 mmHg之间的保守氧合策略并不会增加患者28天的存活率。

对于急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者，美国国家心肺血液研究所(National Heart, Lung, and Blood Institute ARDS)临床试验网络推荐的目标动脉血分压(Pao2)在55~80mmHg之间。近日，顶级医学期刊NEJM上发表了一篇研究文章，研究人员假设以这个范围的下限为目标可以改善ARDS患者的预后。

在这个多中心随机试验中，研究人员分配ARDS患者接受保守性氧疗(目标Pao2为55~70 mmHg;脉搏氧饱和度测定的[Spo2]为88~92%)或自由氧疗法(目标Pao2为90~105 mmHg;Spo2≥96%)，治疗7天。两组采用相同的机械通气策略。最主要的结局是28天内因任何原因死亡。

该研究在纳入205名患者后，由于安全性问题和两组在主要结局上存在显著差异的可能性较低，数据和安全监测委员会提前终止了试验。四名不符合入选标准的患者被排除在外。在第28天，保守性氧疗组99例患者中有34例(34.3%)死亡，自由氧疗组102例患者中有27例(26.5%)死亡(差异为7.8个百分点，95%置信区间[CI]为-4.8至20.6)。在第90天，保守性氧疗组有44.4%的患者死亡，自由氧疗组有30.4%的患者死亡(差异为14.0个百分点，95%置信区间为0.7到27.2)。保守性氧疗组发生5例肠系膜缺血性事件。

由此可见，在ARDS患者中，早期维持Pao2在55~70 mmHg之间的保守氧合策略并不会增加患者28天的存活率。

原始出处：

Loic Barrot,et al.Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome.NEJM.2020.https://www.nejm.org/doi/full/10.1056/NEJMoa1916431

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1431783, encodeId=5b151431e838f, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466555, encodeId=84701466555fc, content=<a href='/topic/show?id=621d6402097' target=_blank style='color:#2F92EE;'>#氧疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64020, encryptionId=621d6402097, topicName=氧疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8a786841989, createdName=rgjl, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582264, encodeId=8e1c158226411, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035167, encodeId=e152103516e20, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Mar 12 11:43:33 CST 2020, time=2020-03-12, status=1, ipAttribution=)]
    2020-03-13 zhouqu_8

    #综合征#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1431783, encodeId=5b151431e838f, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466555, encodeId=84701466555fc, content=<a href='/topic/show?id=621d6402097' target=_blank style='color:#2F92EE;'>#氧疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64020, encryptionId=621d6402097, topicName=氧疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8a786841989, createdName=rgjl, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582264, encodeId=8e1c158226411, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035167, encodeId=e152103516e20, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Mar 12 11:43:33 CST 2020, time=2020-03-12, status=1, ipAttribution=)]
    2020-03-13 rgjl

    #氧疗#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1431783, encodeId=5b151431e838f, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466555, encodeId=84701466555fc, content=<a href='/topic/show?id=621d6402097' target=_blank style='color:#2F92EE;'>#氧疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64020, encryptionId=621d6402097, topicName=氧疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8a786841989, createdName=rgjl, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582264, encodeId=8e1c158226411, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035167, encodeId=e152103516e20, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Mar 12 11:43:33 CST 2020, time=2020-03-12, status=1, ipAttribution=)]
    2020-03-13 12498cf9m40(暂无昵称)

    #呼吸窘迫#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1431783, encodeId=5b151431e838f, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466555, encodeId=84701466555fc, content=<a href='/topic/show?id=621d6402097' target=_blank style='color:#2F92EE;'>#氧疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64020, encryptionId=621d6402097, topicName=氧疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8a786841989, createdName=rgjl, createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582264, encodeId=8e1c158226411, content=<a href='/topic/show?id=e46f396832b' target=_blank style='color:#2F92EE;'>#呼吸窘迫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39683, encryptionId=e46f396832b, topicName=呼吸窘迫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22be16898890, createdName=12498cf9m40(暂无昵称), createdTime=Fri Mar 13 23:43:33 CST 2020, time=2020-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035167, encodeId=e152103516e20, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Mar 12 11:43:33 CST 2020, time=2020-03-12, status=1, ipAttribution=)]
    2020-03-12 旺医

    顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息

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