{"id":16874,"date":"2019-02-19T05:37:53","date_gmt":"2019-02-18T21:37:53","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16874"},"modified":"2019-02-25T05:50:06","modified_gmt":"2019-02-24T21:50:06","slug":"jama%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8-andromeda-shock%e7%a0%94%e7%a9%b6%e8%a1%a8%e6%98%8e%ef%bc%8c%e5%a4%96%e5%91%a8%e7%81%8c%e6%b3%a8%e6%8c%87%e6%a0%87%e6%88%96%e4%b9%b3%e9%85%b8%e6%8c%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16874","title":{"rendered":"[JAMA\u5728\u7ebf\u53d1\u8868]: ANDROMEDA-SHOCK\u7814\u7a76\u8868\u660e\uff0c\u5916\u5468\u704c\u6ce8\u6307\u6807\u6216\u4e73\u9178\u6307\u5bfc\u590d\u82cf\u6cbb\u7597\uff0c\u611f\u67d3\u6027\u4f11\u514b\u60a3\u800528\u5929\u75c5\u6b7b\u7387\u5e76\u65e0\u5dee\u5f02"},"content":{"rendered":"\n

Original Investigation<\/h3>\n\n\n\n

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock\uff1a The ANDROMEDA-SHOCK Randomized Clinical Trial<\/h1>\n\n\n\n

Glenn\u00a0Hern\u00e1ndez,\u00a0Gustavo A.\u00a0Ospina-Tasc\u00f3n,\u00a0Lucas Petri\u00a0Damiani,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online February 17, 2019. doi:10.1001\/jama.2019.0071<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong>\u00a0\u00a0\u80cc\u666f<\/h2>\n\n\n\n

Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established.<\/p>\n\n\n\n

\u611f\u67d3\u6027\u4f11\u514b\u590d\u82cf\u540e\u5916\u5468\u704c\u6ce8\u5f02\u5e38\u5e38\u4f34\u968f\u5668\u5b98\u529f\u80fd\u969c\u788d\u53ca\u6b7b\u4ea1\u3002\u4e34\u5e8a\u8bc4\u4f30\u5916\u5468\u704c\u6ce8\u4f5c\u4e3a\u65e9\u671f\u611f\u67d3\u6027\u4f11\u514b\u590d\u82cf\u6cbb\u7597\u76ee\u6807\u7684\u4f5c\u7528\u5c1a\u672a\u660e\u786e\u3002<\/p>\n\n\n\n

Objective<\/strong>\u00a0\u00a0\u76ee\u7684<\/h2>\n\n\n\n

To determine if a peripheral perfusion\u2013targeted resuscitation during early septic shock in adults is more effective than a lactate level\u2013targeted resuscitation for reducing mortality.<\/p>\n\n\n\n

\u5bf9\u4e8e\u65e9\u671f\u611f\u67d3\u6027\u4f11\u514b\u6210\u5e74\u60a3\u8005\u800c\u8a00\uff0c\u4e0e\u4e73\u9178\u6c34\u5e73\u6307\u5bfc\u7684\u590d\u82cf\u6cbb\u7597\u76f8\u6bd4\uff0c\u786e\u5b9a\u4ee5\u5916\u5468\u704c\u6ce8\u4e3a\u76ee\u6807\u7684\u590d\u82cf\u6cbb\u7597\u80fd\u591f\u964d\u4f4e\u75c5\u6b7b\u7387\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>\u00a0\u00a0\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u5bf9\u8c61<\/h2>\n\n\n\n

Multicenter, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018.<\/p>\n\n\n\n

\u57285\u4e2a\u56fd\u5bb628\u4e2aICU\u8fdb\u884c\u7684\u591a\u4e2d\u5fc3\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u30022017\u5e743\u6708\u81f32018\u5e743\u6708\u5171\u5165\u9009424\u540d\u611f\u67d3\u6027\u4f11\u514b\u60a3\u8005\u3002\u6700\u540e\u968f\u8bbf\u65e5\u671f\u4e3a2018\u5e746\u670812\u65e5\u3002<\/p>\n\n\n\n

Interventions<\/strong>\u00a0\u00a0\u5e72\u9884\u63aa\u65bd<\/h2>\n\n\n\n

Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n\u2009=\u2009212) or normalizing or decreasing lactate levels at rates greater than 20% per 2 hours (n\u2009=\u2009212), during an 8-hour intervention period.<\/p>\n\n\n\n

\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c\u57288\u4e2a\u5c0f\u65f6\u7684\u5e72\u9884\u6cbb\u7597\u671f\u95f4\uff0c\u901a\u8fc7\u9010\u6b65\u590d\u82cf\u6cbb\u7597\u65b9\u6848\u5206\u522b\u4f7f\u6bdb\u7ec6\u8840\u7ba1\u518d\u5145\u76c8\u65f6\u95f4\u6b63\u5e38 (n\u2009=\u2009212) \u6216\u4f7f\u4e73\u9178\u6c34\u5e73\u6062\u590d\u6b63\u5e38\u6216\u4e0b\u964d(> 20%\/2 h) (n\u2009=\u2009212)\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>\u00a0\u00a0\u4e3b\u8981\u9884\u540e\u6307\u6807<\/h2>\n\n\n\n

The primary outcome was all-cause mortality at 28 days. Secondary outcomes were organ dysfunction at 72 hours after randomization, as assessed by Sequential Organ Failure Assessment (SOFA) score (range, 0 [best] to 24 [worst]); death within 90 days; mechanical ventilation\u2013, renal replacement therapy\u2013, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a28\u5929\u5168\u56e0\u75c5\u6b7b\u7387\u3002\u6b21\u8981\u9884\u540e\u6307\u6807\u4e3a\u968f\u673a\u5206\u7ec4\u540e72\u5c0f\u65f6\u5668\u5b98\u529f\u80fd\u969c\u788d\uff0c\u901a\u8fc7SOFA\u8bc4\u5206\u8fdb\u884c\u8bc4\u4f30\uff08\u8303\u56f40 [\u6700\u597d] \u81f3 24 [\u6700\u5dee]\uff09\uff1b90\u5929\u75c5\u6b7b\u7387\uff1b28\u5929\u5185\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\uff0c\u65e0\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u5929\u6570\u53ca\u65e0\u5347\u538b\u836f\u7269\u5929\u6570\uff1bICU\u4f4f\u9662\u65e5\u53ca\u603b\u4f4f\u9662\u65e5\u3002<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0\u7ed3\u679c<\/h2>\n\n\n\n

Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial. By day 28, 74 patients (34.9%) in the peripheral perfusion group and 92 patients (43.4%) in the lactate group had died (hazard ratio, 0.75 [95% CI, 0.55 to 1.02];\u00a0P<\/em>\u2009=\u2009.06; risk difference, \u22128.5% [95% CI, \u221218.2% to 1.2%]). Peripheral perfusion\u2013targeted resuscitation was associated with less organ dysfunction at 72 hours (mean SOFA score, 5.6 [SD, 4.3] vs 6.6 [SD, 4.7]; mean difference, \u22121.00 [95% CI, \u22121.97 to \u22120.02];\u00a0P<\/em>\u2009=\u2009.045). There were no significant differences in the other 6 secondary outcomes. No protocol-related serious adverse reactions were confirmed.<\/p>\n\n\n\n

\u5171\u6709424\u540d\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff08\u5e73\u5747\u5e74\u9f8463\u5c81\uff1b226\u540d [53%] \u5973\u6027\uff09\uff0c416\u540d (98%) \u5b8c\u6210\u8bd5\u9a8c\u3002\u81f3\u7b2c28\u5929\u65f6\uff0c\u5916\u5468\u5173\u6ce8\u7ec474\u540d(34.9%)\u60a3\u8005\u53ca\u4e73\u9178\u7ec492\u540d(43.4%)\u60a3\u8005\u6b7b\u4ea1\uff08\u98ce\u9669\u6bd4\uff0c0.75 [95% CI, 0.55 to 1.02];\u00a0P<\/em>\u2009=\u2009.06\uff1b\u98ce\u9669\u5dee\u5f02\uff0c\u22128.5% [95% CI, \u221218.2% to 1.2%]\uff09\u3002\u5916\u5468\u5173\u6ce8\u4e3a\u76ee\u6807\u7684\u590d\u82cf\u6cbb\u7597\u60a3\u800572\u5c0f\u65f6\u5668\u5b98\u529f\u80fd\u969c\u788d\u66f4\u5c11\uff08\u5e73\u5747SOFA\u8bc4\u5206\uff0c5.6 [SD, 4.3] vs 6.6 [SD, 4.7]\uff1b\u5e73\u5747\u5dee\u5f02\uff0c\u22121.00 [95% CI, \u22121.97 to \u22120.02];\u00a0P<\/em>\u2009=\u2009.045\uff09\u3002\u5176\u4ed66\u9879\u6b21\u8981\u9884\u540e\u6307\u6807\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002\u6ca1\u6709\u53d1\u73b0\u6cbb\u7597\u65b9\u6848\u76f8\u5173\u7684\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>\u00a0\u00a0\u7ed3\u8bba\u4e0e\u610f\u4e49<\/h2>\n\n\n\n

Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality.<\/p>\n\n\n\n

\u5bf9\u4e8e\u611f\u67d3\u6027\u4f11\u514b\u60a3\u8005\uff0c\u4e0e\u8840\u4e73\u9178\u6c34\u5e73\u6307\u5bfc\u7684\u590d\u82cf\u6cbb\u7597\u7b56\u7565\u76f8\u6bd4\uff0c\u65e8\u5728\u6062\u590d\u6b63\u5e38\u6bdb\u7ec6\u8840\u7ba1\u5145\u76c8\u65f6\u95f4\u7684\u590d\u82cf\u7b56\u7565\u4e0d\u80fd\u964d\u4f4e28\u5929\u75c5\u6b7b\u7387\u3002<\/p>\n\n\n\n

Trial Registration<\/strong>\u00a0\u00a0\u8bd5\u9a8c\u6ce8\u518c<\/h2>\n\n\n\n

ClinicalTrials.gov Identifier:\u00a0NCT03078712<\/a><\/p>\n\n\n\n


<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation Effect of a Resuscitation Strate […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16874"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16874"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16874\/revisions"}],"predecessor-version":[{"id":16877,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16874\/revisions\/16877"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16874"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16874"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16874"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}