JAMA:维生素C、皮质类固醇和维生素B1联合治疗对脓毒性休克患者器官衰竭的影响

2020-08-22 MedSci原创 MedSci原创

在脓毒性休克患者中,联合应用维生素C、皮质类固醇和维生素B1对改善患者序贯器官衰竭评估得分没有显著影响

近日研究人员考察了维生素C-皮质类固醇联合维生素B1治疗对改善感染性休克患者器官损伤的影响。

研究在美国的14个中心开展,205名成人脓毒性休克患者参与,随机接受肠外维生素C(1500mg)、氢化可的松(50mg)和维生素B1(100mg)治疗,每6小时一次,连续4天(n=103)或安慰剂(n=102)。研究的主要结果是在入组到72小时之间,序贯器官衰竭评估(SOFA)得分(范围0-24;0=最佳)的变化。次要结果包括肾衰竭和30天死亡率。

患者平均年龄68岁,90名女性,有200名患者(98%)接受了至少一剂研究药物。总的来说,在入组后72小时内,组间SOFA评分改善没有显著的统计学差异(干预组的SOFA评分平均值从9.1下降到4.4分 vs 安慰剂组从9.2下降到5.1分;调整后的平均差异-0.8)。

肾衰竭的发生率(干预组为31.7% vs 安慰剂组为27.3%;校正后的风险差为0.03%)或30天死亡率(分别为34.7% vs 29.3%;危险比为1.3)差异不显著。

最常见的严重不良事件是高血糖(干预组12例,安慰剂组7例)、高钠血症(分别为11例和7例)和新发院内获得性感染(分别为13例和12例)。

在脓毒性休克患者中,联合应用维生素C、皮质类固醇和维生素B1对改善患者序贯器官衰竭评估得分没有显著影响。

原始出处:

Ari Moskowitz et al. Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock The ACTS Randomized Clinical Trial. JAMA, August 18, 2020.

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createdBy=db5b227, createdName=gostraight, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313455, encodeId=34211313455ae, content=<a href='/topic/show?id=d59be61251d' target=_blank style='color:#2F92EE;'>#类固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76125, encryptionId=d59be61251d, topicName=类固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313802, encodeId=25e4131380280, content=<a href='/topic/show?id=d4cc80e128f' target=_blank style='color:#2F92EE;'>#联合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80712, encryptionId=d4cc80e128f, topicName=联合治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508555, encodeId=d6bc1508555a5, content=<a href='/topic/show?id=68b0e9055f7' target=_blank style='color:#2F92EE;'>#维生素B#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79055, encryptionId=68b0e9055f7, topicName=维生素B)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=17599981768, createdName=马龙, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=812493, encodeId=46da81249336, content=不错 点赞收藏学习起来<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sun Aug 23 19:52:41 CST 2020, time=2020-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036232, encodeId=6b701036232c4, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 22 12:10:20 CST 2020, time=2020-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811970, encodeId=0a4f8119e0d2, content=<a href='/topic/show?id=7b63e9065ee' target=_blank style='color:#2F92EE;'>#维生素C#</a>、<a href='/topic/show?id=203ce2170be' target=_blank style='color:#2F92EE;'>#皮质类固醇#</a>和<a href='/topic/show?id=1c7ce9056de' target=_blank style='color:#2F92EE;'>#维生素B1#</a>可能作用都比较弱,对于VitC还要看是不是超大剂量(即每日12-24g)才可能对<a href='/topic/show?id=7a2f851921d' target=_blank style='color:#2F92EE;'>#脓毒症#</a>有效的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=231, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79065, encryptionId=7b63e9065ee, topicName=维生素C), TopicDto(id=72170, encryptionId=203ce2170be, topicName=皮质类固醇), TopicDto(id=79056, encryptionId=1c7ce9056de, topicName=维生素B1), TopicDto(id=85192, encryptionId=7a2f851921d, topicName=脓毒症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Aug 22 09:26:37 CST 2020, time=2020-08-22, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1687114, encodeId=b4cc168e114fd, 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=35, 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=Sun Nov 08 05:10:20 CST 2020, time=2020-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290295, encodeId=6ddf129029546, content=<a href='/topic/show?id=7d058518e56' target=_blank style='color:#2F92EE;'>#脓毒性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85187, encryptionId=7d058518e56, topicName=脓毒性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313455, encodeId=34211313455ae, content=<a href='/topic/show?id=d59be61251d' target=_blank style='color:#2F92EE;'>#类固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76125, encryptionId=d59be61251d, topicName=类固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313802, encodeId=25e4131380280, content=<a href='/topic/show?id=d4cc80e128f' target=_blank style='color:#2F92EE;'>#联合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80712, encryptionId=d4cc80e128f, topicName=联合治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508555, encodeId=d6bc1508555a5, content=<a href='/topic/show?id=68b0e9055f7' target=_blank style='color:#2F92EE;'>#维生素B#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79055, encryptionId=68b0e9055f7, topicName=维生素B)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=17599981768, createdName=马龙, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=812493, encodeId=46da81249336, content=不错 点赞收藏学习起来<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sun Aug 23 19:52:41 CST 2020, time=2020-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036232, encodeId=6b701036232c4, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 22 12:10:20 CST 2020, time=2020-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811970, encodeId=0a4f8119e0d2, content=<a href='/topic/show?id=7b63e9065ee' target=_blank style='color:#2F92EE;'>#维生素C#</a>、<a href='/topic/show?id=203ce2170be' target=_blank style='color:#2F92EE;'>#皮质类固醇#</a>和<a href='/topic/show?id=1c7ce9056de' target=_blank style='color:#2F92EE;'>#维生素B1#</a>可能作用都比较弱,对于VitC还要看是不是超大剂量(即每日12-24g)才可能对<a href='/topic/show?id=7a2f851921d' target=_blank style='color:#2F92EE;'>#脓毒症#</a>有效的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=231, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79065, encryptionId=7b63e9065ee, topicName=维生素C), TopicDto(id=72170, encryptionId=203ce2170be, topicName=皮质类固醇), TopicDto(id=79056, encryptionId=1c7ce9056de, topicName=维生素B1), TopicDto(id=85192, encryptionId=7a2f851921d, topicName=脓毒症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Aug 22 09:26:37 CST 2020, time=2020-08-22, status=1, ipAttribution=)]
    2020-08-24 马龙
  6. 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encryptionId=d4cc80e128f, topicName=联合治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508555, encodeId=d6bc1508555a5, content=<a href='/topic/show?id=68b0e9055f7' target=_blank style='color:#2F92EE;'>#维生素B#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79055, encryptionId=68b0e9055f7, topicName=维生素B)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=17599981768, createdName=马龙, createdTime=Mon Aug 24 00:10:20 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=812493, encodeId=46da81249336, content=不错 点赞收藏学习起来<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sun Aug 23 19:52:41 CST 2020, time=2020-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036232, encodeId=6b701036232c4, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 22 12:10:20 CST 2020, time=2020-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811970, encodeId=0a4f8119e0d2, content=<a href='/topic/show?id=7b63e9065ee' target=_blank style='color:#2F92EE;'>#维生素C#</a>、<a href='/topic/show?id=203ce2170be' target=_blank style='color:#2F92EE;'>#皮质类固醇#</a>和<a href='/topic/show?id=1c7ce9056de' target=_blank style='color:#2F92EE;'>#维生素B1#</a>可能作用都比较弱,对于VitC还要看是不是超大剂量(即每日12-24g)才可能对<a href='/topic/show?id=7a2f851921d' target=_blank style='color:#2F92EE;'>#脓毒症#</a>有效的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=231, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79065, encryptionId=7b63e9065ee, topicName=维生素C), TopicDto(id=72170, encryptionId=203ce2170be, topicName=皮质类固醇), TopicDto(id=79056, encryptionId=1c7ce9056de, topicName=维生素B1), TopicDto(id=85192, encryptionId=7a2f851921d, topicName=脓毒症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Aug 22 09:26:37 CST 2020, time=2020-08-22, status=1, ipAttribution=)]
    2020-08-23 仁心济世

    不错 点赞收藏学习起来#学习#

    0

  7. 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href='/topic/show?id=7b63e9065ee' target=_blank style='color:#2F92EE;'>#维生素C#</a>、<a href='/topic/show?id=203ce2170be' target=_blank style='color:#2F92EE;'>#皮质类固醇#</a>和<a href='/topic/show?id=1c7ce9056de' target=_blank style='color:#2F92EE;'>#维生素B1#</a>可能作用都比较弱,对于VitC还要看是不是超大剂量(即每日12-24g)才可能对<a href='/topic/show?id=7a2f851921d' target=_blank style='color:#2F92EE;'>#脓毒症#</a>有效的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=231, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79065, encryptionId=7b63e9065ee, topicName=维生素C), TopicDto(id=72170, encryptionId=203ce2170be, topicName=皮质类固醇), TopicDto(id=79056, encryptionId=1c7ce9056de, topicName=维生素B1), TopicDto(id=85192, encryptionId=7a2f851921d, topicName=脓毒症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Aug 22 09:26:37 CST 2020, time=2020-08-22, status=1, ipAttribution=)]
    2020-08-22 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

    0

  8. 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2020, time=2020-08-22, status=1, ipAttribution=)]
    2020-08-22 lovetcm

    #维生素C##皮质类固醇##维生素B1#可能作用都比较弱,对于VitC还要看是不是超大剂量(即每日12-24g)才可能对#脓毒症#有效的。

    0

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