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[Critical Care发表论文]:动态监测乳酸水平指导血流动力学治疗可能改善感染相关高乳酸血症患者预后
2017年06月18日 时讯速递, 进展交流 暂无评论

Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia

Xiang ZhouDawei LiuLongxiang Su, et al

Critical Care 2017; 21: 33

DOI: 10.1186/s13054-017-1617-1

Background 背景

Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation.

将乳酸清除率设置为> 30%可能改善全身性感染相关高乳酸血症患者的临床预后。本研究的目的是在早期复苏时,以6小时动态监测乳酸水平或中心静脉血氧饱和度 (ScvO2) 为目标的血流动力学治疗对预后的影响。

Methods 方法

The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared.

360名全身性感染相关高乳酸血症患者接受随机分组,记录并比较相关指标及不良事件。

Results 结果

Heart rate (HR) at 48 h in the ScvO2 group was higher than in the lactate kinetics group (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040). The liquid balance at 4 h, 12 h, and 24 h in the lactate kinetics group was larger than in the ScvO2 group (1535 (1271–1778) ml vs 826 (631–1219) ml, P < 0.001; 1688 (1173–1923) ml vs 1277 (962 − 1588) ml, P <0.001; and 1510 (904–2087) ml vs 1236 (740–1808) ml, P = 0.005), respectively. Mortality was higher in the ScvO2 group (27.9% vs 18.3%, P = 0.033), but there was no significant difference between the two groups in the length of stay in the ICU or mechanical ventilation. In terms of new onset organ dysfunction, there was a significant difference between the two groups in total bilirubin at 48 h and 72 h. Based on the 60-day survival curves, there was significantly more mortality in the ScvO2 group than in the lactate kinetics group (X 2 = 4.133, P = 0.042). In addition, fewer adverse events occurred in the lactate kinetics group.

ScvO2 组48小时心率 (HR) 较动态乳酸组更快 (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040)。动态乳酸组4小时,12小时及24小时液体平衡较ScvO2 组更多 (1535 (1271–1778) ml vs 826 (631–1219) ml, P < 0.001; 1688 (1173–1923) ml vs 1277 (962 − 1588) ml, P <0.001; 1510 (904–2087) ml vs 1236 (740–1808) ml, P = 0.005)。ScvO2 组病死率更高 (27.9% vs 18.3%, P = 0.033),但两组患者ICU住院日及机械通气时间并无差异。在新发器官功能不全方面,两组患者48小时和72小时总胆红素存在显著差异。60天生存曲线显示,ScvO2 组病死率显著高于动态乳酸组 (X 2 = 4.133, P = 0.042)。另外,动态乳酸组不良事件发生率更低。

  

Conclusions 结论

Stepwise lactate kinetics-oriented hemodynamic therapy can reduce mortality in patients with sepsis-associated hyperlactatemia compared with ScvO2-oriented therapy.

对于全身性感染相关高乳酸血症患者,与ScvO指导治疗相比,动态乳酸指导血流动力学治疗能够降低病死率。

Trial registration

National Institutes of Health Clinical Trials Registry, NCT02566460. Registered on 26 September 2015.

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