重症医学治疗措施调整临床研究进展  

Update in the Management of Intensive Care Medicine

作　　者：刘相德[1] 

机构地区：[1]美国内布拉斯加大学医学中心呼吸与重症病科

出　　处：《创伤与急危重病医学》2014年第2期69-72,共4页Trauma and Critical Care Medicine

摘　　要：近年来,新的临床随机试验结果提示,目前重症医学领域应用的一些传统治疗方法需要调整。本文通过收集整理近年来报道的随机临床试验研究结果,归纳了需要调整的一些治疗方法:(1)控制液体输入量对急性呼吸窘迫综合征(ARDS)患者有益。肺动脉插管不再是ARDS的常规应用方法。(2)尽管激素能改善氧合作用,如果ARDS发病14 d以后才开始应用激素治疗,其最终治疗效果不佳。(3)对于机械通气的患者,每日试着终止应用镇静药物,并尽早让患者处于清醒状态,有助于获得良好治疗效果。(4)休克患者大量应用胰岛素可能导致低血糖症,并可能导致多种并发症。(5)对于脓毒症休克患者,激素可能有助于快速逆转休克的恶化,但是对病死率的改善作用仍有争议。(6)垂体后叶素有助于改善休克患者血流动力学,但是与降低病死率无关。(7)与去甲肾上腺素相比,多巴胺对于休克患者心脏的副作用更大。Findings of recent new clinical trials in critically ill patients indicate that several traditional treatment strategies in critical care need to be modified.The author reviewed recent literatures of clinical trials on critically ill patients and summa-rized as following changes in the practice.（1 ）In patients with ARDS,fluid restriction gives better outcomes than a liberal fluid policy.A pulmonary arterial catheter is no longer necessary to be a routine procedure in ARDS.（2）Although cortico-steroids may improve oxygenation,late use of corticosteroids in ARDS patients （＆gt;14 days after diagnosis）is not indicated and may increase risk of death.（3）Daily interruption of sedation and early awakening of mechanically ventilated patients is safe and may shorten the length of ventilation.（4）Intensive insulin therapy in shock patient is associated with hypoglycemia and can cause many complications.（5 ）Corticosteroids therapy can result in faster shock reversal,but its effect on mortality remain controversial.（6）Vasopressin can improve hemodynamic in shock patients,but its use is not associated with an im-provement in mortality rates.（7）Compared to norepinephrine,dopamine may result in a greater number of cardiac adverse events.

关 键 词：临床试验 重症医学 急重症治疗 

分 类 号：R459.7[医药卫生—急诊医学]