{"id":17237,"date":"2019-05-28T05:17:53","date_gmt":"2019-05-27T21:17:53","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17237"},"modified":"2019-06-09T05:26:41","modified_gmt":"2019-06-08T21:26:41","slug":"nejm%e6%9c%80%e6%96%b0%e5%8f%91%e8%a1%a8%ef%bc%9a%e6%97%a9%e6%9c%9f%e4%bd%bf%e7%94%a8%e8%82%8c%e6%9d%be%e8%8d%af%e7%89%a9%e4%b8%8d%e8%83%bd%e9%99%8d%e4%bd%8eards%e7%97%85%e6%ad%bb%e7%8e%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17237","title":{"rendered":"[NEJM\u6700\u65b0\u53d1\u8868]\uff1a\u65e9\u671f\u4f7f\u7528\u808c\u677e\u836f\u7269\u4e0d\u80fd\u964d\u4f4eARDS\u75c5\u6b7b\u7387"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome<\/h1>\n\n\n\n

The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network<\/h3>\n\n\n\n

N Engl J Med May 19, 2019
DOI: 10.1056\/NEJMoa1901686<\/h3>\n\n\n\n

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

BACKGROUND \u80cc\u666f<\/h2>\n\n\n\n

The benefits of early continuous neuromuscular blockade in patients with acute respiratory distress syndrome (ARDS) who are receiving mechanical ventilation remain unclear.<\/p>\n\n\n\n

\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u65e9\u671f\u4f7f\u7528\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\u7684\u83b7\u76ca\u5c1a\u4e0d\u6e05\u695a\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h2>\n\n\n\n

We randomly assigned patients with moderate-to-severe ARDS (defined by a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure [PEEP] of \u22658 cm of water) to a 48-hour continuous infusion of cisatracurium with concomitant deep sedation (intervention group) or to a usual-care approach without routine neuromuscular blockade and with lighter sedation targets (control group). The same mechanical-ventilation strategies were used in both groups, including a strategy involving a high PEEP. The primary end point was in-hospital death from any cause at 90 days.<\/p>\n\n\n\n

\u6211\u4eec\u5c06\u4e2d\u91cd\u5ea6ARDS\uff08\u5b9a\u4e49\u4e3aPEEP \u2265 8 cmH2O\u65f6PaO2\/FiO2 < 150 mmHg\uff09\u60a3\u8005\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d748\u5c0f\u65f6\u6301\u7eed\u8f93\u6ce8\u987a\u5f0f\u963f\u66f2\u5e93\u80fa\uff0c\u540c\u65f6\u7ed9\u4e88\u6df1\u5ea6\u9547\u9759\uff08\u5e72\u9884\u7ec4\uff09\uff0c\u6216\u5e38\u89c4\u7ec4\uff08\u4e0d\u5e38\u89c4\u4f7f\u7528\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff0c\u8f7b\u5ea6\u9547\u9759\u4e3a\u76ee\u6807\uff09\uff08\u5bf9\u7167\u7ec4\uff09\u3002\u4e24\u7ec4\u60a3\u8005\u673a\u68b0\u901a\u6c14\u7b56\u7565\u76f8\u540c\uff0c\u5305\u62ec\u9ad8PEEP\u3002\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a90\u5929\u5168\u56e0\u4f4f\u9662\u75c5\u6b7b\u7387\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h2>\n\n\n\n

The trial was stopped at the second interim analysis for futility. We enrolled 1006 patients early after the onset of moderate-to-severe ARDS (median, 7.6 hours after onset). During the first 48 hours after randomization, 488 of the 501 patients (97.4%) in the intervention group started a continuous infusion of cisatracurium (median duration of infusion, 47.8 hours; median dose, 1807 mg), and 86 of the 505 patients (17.0%) in the control group received a neuromuscular blocking agent (median dose, 38 mg). At 90 days, 213 patients (42.5%) in the intervention group and 216 (42.8%) in the control group had died before hospital discharge (between-group difference, \u22120.3 percentage points; 95% confidence interval, \u22126.4 to 5.9; P=0.93). While in the hospital, patients in the intervention group were less physically active and had more adverse cardiovascular events than patients in the control group. There were no consistent between-group differences in end points assessed at 3, 6, and 12 months.<\/p>\n\n\n\n

\u8bd5\u9a8c\u56e0\u65e0\u6548\u5728\u7b2c\u4e8c\u6b21\u4e2d\u671f\u5206\u6790\u540e\u7ed3\u675f\u3002\u6211\u4eec\u5165\u9009\u4e861006\u540d\u65e9\u671f\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\uff08\u4e2d\u4f4d\u65f6\u95f4\uff0c\u53d1\u75c5\u540e7.6\u5c0f\u65f6\uff09\u3002\u5728\u968f\u673a\u5206\u7ec4\u540e\u6700\u521d48\u5c0f\u65f6\u5185\uff0c\u5e72\u9884\u7ec4501\u540d\u60a3\u8005\u4e2d488\u540d(97.4%)\u5f00\u59cb\u6301\u7eed\u8f93\u6ce8\u987a\u5f0f\u963f\u66f2\u5e93\u80fa\uff08\u8f93\u6ce8\u4e2d\u4f4d\u65f6\u95f447.8\u5c0f\u65f6\uff1b\u4e2d\u4f4d\u5242\u91cf\uff0c1807 mg\uff09\uff1b\u5bf9\u7167\u7ec4505\u540d\u60a3\u8005\u4e2d86\u540d(17.0%)\u4f7f\u7528\u4e86\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff08\u4e2d\u4f4d\u5242\u91cf38 mg\uff09\u300290\u5929\u65f6\uff0c\u5e72\u9884\u7ec4213\u540d\u60a3\u8005(42.5%)\u53ca\u5bf9\u7167\u7ec4216\u540d\u60a3\u8005(42.8%)\u4f4f\u9662\u671f\u95f4\u6b7b\u4ea1\uff08\u7ec4\u95f4\u5dee\u5f02\uff0c-0.3\u767e\u5206\u70b9\uff1b95%\u53ef\u4fe1\u533a\u95f4-6.4 to 5.9\uff1bp=0.93\uff09\u3002\u5728\u4f4f\u9662\u671f\u95f4\uff0c\u5e72\u9884\u7ec4\u60a3\u8005\u4e3b\u52a8\u6d3b\u52a8\u66f4\u5c11\uff0c\u5fc3\u8840\u7ba1\u4e0d\u826f\u4e8b\u4ef6\u66f4\u591a\u3002\u5728\u7b2c3\u30016\u548c12\u4e2a\u6708\u65f6\uff0c\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e24\u7ec4\u95f4\u6ca1\u6709\u5dee\u5f02\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

CONCLUSIONS \u7ed3\u8bba<\/h2>\n\n\n\n

Among patients with moderate-to-severe ARDS who were treated with a strategy involving a high PEEP, there was no significant difference in mortality at 90 days between patients who received an early and continuous cisatracurium infusion and those who were treated with a usual-care approach with lighter sedation targets. (Funded by the National Heart, Lung, and Blood Institute; ROSE ClinicalTrials.gov number,\u00a0NCT02509078<\/a>.)<\/p>\n\n\n\n

\u5bf9\u4e8e\u63a5\u53d7\u9ad8PEEP\u7684\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\uff0c\u65e9\u671f\u6301\u7eed\u8f93\u6ce8\u987a\u5f0f\u963f\u66f2\u5e93\u80fa\u7684\u60a3\u8005\u4e0e\u4ee5\u6d45\u9547\u9759\u4e3a\u76ee\u6807\u7684\u5e38\u89c4\u6cbb\u7597\u60a3\u8005\u95f490\u5929\u75c5\u6b7b\u7387\u65e0\u663e\u8457\u5dee\u5f02\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Early Neuromuscular Blockade in the Ac […]<\/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\/17237"}],"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=17237"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17237\/revisions"}],"predecessor-version":[{"id":17248,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17237\/revisions\/17248"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17237"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17237"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17237"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}