NEJM:氢化可的松不能降低脓毒性休克者的死亡率

2018-04-01 杨中华 脑血管病及重症文献导读

当前临床指南推荐,如果经过充足的液体复苏和升压药物治疗后,血流动力学仍不稳定的脓毒性休克患者可以给予氢化可的松治疗。但是该推荐意见基于低质量的证据,推荐水平也较弱。


当前临床指南推荐,如果经过充足的液体复苏和升压药物治疗后,血流动力学仍不稳定的脓毒性休克患者可以给予氢化可的松治疗。但是该推荐意见基于低质量的证据,推荐水平也较弱。

2018年3月来自澳大利亚卫斯理医院的B. Venkatesh等在NEJM上公布了ADRENAL试验结果,目的在于探讨氢化可的松是否可以降低脓毒性休克患者的死亡率。

纳入的患者为机械通气的脓毒性休克患者,随机给予氢化可的松(200mg/d,200mg氢化可的松配成200ml溶液,持续输注24h)或安慰剂,共7天或直到死亡或转出ICU。主要终点为90天死亡。

从2013年3月到2017年4月共随机了3800例患者,能够确认主要终点的患者共3658例。氢化可的松和安慰剂90天死亡率分别为27.9%和28.8%(OR, 0.95; 95% CI, 0.82 to 1.10; P = 0.50)。在六项预先设定的亚组中,治疗方案的疗效无差异。氢化可的松组(vs 安慰剂)休克缓解的速度更快(平均持续时间, 3 天[四分位距, 2 to 5] vs. 4 天 [ 四分位距, 2 to 9]; HR, 1.32; 95% CI, 1.23 to 1.41; P<0.001)。氢化可的松组(vs 安慰剂)初次呼吸机使用持续时间更短(平均, 6 天 [ 四分位距, 3 to 18] vs. 7 天 [四分位距, 3 to 24]; HR, 1.13; 95% CI, 1.05 to 1.22; P<0.001)。

最终作者认为对于机械通气的脓毒性休克患者,持续输注氢化可的松不能降低90天死亡率(vs 安慰剂)。

原始出处:

Balasubramanian Venkatesh,et al.Adjunctive Glucocorticoid Therapy in Patients with Septic Shock.N Engl J Med. 2018 Mar 1;378(9):797-808. doi: 10.1056/NEJMoa1705835. Epub 2018 Jan 19.

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    2018-04-04 一个字-牛

    学习了谢谢分享

    0

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2018, time=2018-04-02, status=1, ipAttribution=)]
  5. 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createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301898, encodeId=c330301898f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon Apr 02 05:25:10 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301895, encodeId=722a3018958d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Mon Apr 02 05:23:58 CST 2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-03 wzb521zf

    一起学习学习

    0

  6. 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createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301898, encodeId=c330301898f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon Apr 02 05:25:10 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301895, encodeId=722a3018958d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Mon Apr 02 05:23:58 CST 2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-03 changjiu

    学习一下谢谢

    0

  7. 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createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301898, encodeId=c330301898f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon Apr 02 05:25:10 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301895, encodeId=722a3018958d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Mon Apr 02 05:23:58 CST 2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-02 owlhealth

    不错耶.学习了

    0

  8. 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createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301898, encodeId=c330301898f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon Apr 02 05:25:10 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301895, encodeId=722a3018958d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Mon Apr 02 05:23:58 CST 2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-02 owlhealth

    不错耶.学习了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1687096, encodeId=45e9168e0960c, content=<a href='/topic/show?id=b038851865c' target=_blank style='color:#2F92EE;'>#脓毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85186, encryptionId=b038851865c, topicName=脓毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dd9828318255, createdName=1249857fm41暂无昵称, createdTime=Tue Jun 19 07:56:00 CST 2018, time=2018-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302619, encodeId=0a93302619f1, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160304/IMG56D94856B1B5D6405.jpg, createdBy=27931687771, createdName=一个字-牛, createdTime=Wed Apr 04 08:13:58 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Tue Apr 03 03:01:50 CST 2018, time=2018-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302040, encodeId=69013020403c, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:37 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302039, encodeId=f96a302039f3, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Apr 02 11:45:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301898, encodeId=c330301898f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon Apr 02 05:25:10 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301895, encodeId=722a3018958d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Mon Apr 02 05:23:58 CST 2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-02 秀红

    学习了

    0

  10. 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2018, time=2018-04-02, status=1, ipAttribution=)]
    2018-04-02 121832a9m88暂无昵称

    学习了

    0

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