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[Ann Emerg Med在线发表]:床旁超声检查不能改善急诊低血压患者的临床预后
2018年07月06日 时讯速递, 进展交流 暂无评论

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators

Paul R. Atkinson,James Milne, Laura Diegelmann, et al

Ann Emerg Med. 2018

Study objective: 研究目的

Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes.

床旁超声方案常用于急诊未分化低血压患者的初始诊治,但有关病死率获益的证据还很少。我们比较了床旁超声方案与无床旁超声的标准治疗对生存率及临床预后的影响。

Methods: 方法

This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography. Diagnoses were recorded at 0 and 60 minutes. The primary outcome measure was survival to 30 days or hospital discharge. Secondary outcome measures included initial treatment and investigations, admissions, and length of stay.

北美和南非6个中心参加的这项国际多中心随机对照试验纳入低血压患者(收缩压< 100 mmHg或休克指数> 1),并随机分为早期床旁超声加标准治疗与无床旁超声的标准治疗。在0分钟和60分钟记录诊断。主要预后指标为30天或住院生存率。次要预后指标包括初始治疗与评估,住院治疗及住院日。

Results: 结果

Follow-up was completed for 270 of 273 patients. The most common diagnosis in more than half the patients was occult sepsis. We found no important differences between groups for the primary outcome of survival (point-of-care ultrasonography group 104 of 136 patients versus standard care 102 of 134 patients; difference 0.35%; 95% binomial confidence interval [CI] –10.2% to 11.0%), survival in North America (point-of-care ultrasonography group 76 of 89 patients versus standard care 72 of 88 patients; difference 3.6%; CI –8.1% to 15.3%), and survival in South Africa (point-of-care ultrasonography group 28 of 47 patients versus standard care 30 of 46 patients; difference 5.6%; CI –15.2% to 26.0%). There were no important differences in rates of computed tomography (CT) scanning, inotrope or intravenous fluid use, and ICU or total length of stay.

入选的273名患者中共有270名完成了随访。超过半数患者最常见的诊断为隐性全身性感染。我们并未发现两组患者的主要预后指标存在显著差异(床旁超声组104/136 vs. 标准治疗组102/134;差异0.35%;95%二项可信区间[CI] -10.2% to 11.0%),北美(床旁超声组76/89 vs. 标准治疗组72/88;差异3.5%;95% CI -8.1% to 15.3%)及南非(床旁超声组28/47 vs. 标准治疗组30/46;差异5.6%;95% CI -15.2% to 26.0%)两组患者的生存率也没有差异。两组患者CT扫描比例、使用强心药物或静脉输液比例、ICU住院日及总住院日也没有差异。

Conclusion: 结论

To our knowledge, this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration. The addition of a point-ofcare ultrasonography protocol to standard care may not translate into a survival benefit in this group.

据我们所知,这是比较床旁超声与不包括床旁超声在内的标准治疗用于未分化低血压急诊患者的第一项随机对照试验。我们没有发现生存率、住院日、CT扫描、使用强心药物或静脉输液比例存在显著差异。在标准治疗的基础上,床旁超声方案不能改善此类患者的生存。

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