Rheo-STAT项目。从证据的角度看中毒综合征治疗的新选择:强调肺炎

Dinh Thi Hoa, S. Beridze
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引用次数: 0

摘要

背景。肺炎是一种广泛存在的疾病,在越南和格鲁吉亚都经常导致住院治疗。肺炎的支持性治疗包括呼吸支持、液体和电解质平衡支持、肠外营养和一些附加药物(镇痛药、皮质类固醇、肌力药物)。Rheo-STAT研究是一项介入性开放标签随机对照研究,研究Reosorbilact(“Yuria-Pharm”)治疗肺炎的有效性。这项研究在7个国家进行(乌克兰、摩尔多瓦、格鲁吉亚、越南、哈萨克斯坦、吉尔吉斯斯坦、乌兹别克斯坦)。目标。目的:评价Reosorbilact在消除中毒综合征中的有效性。材料和方法。628例脓毒症、腹膜炎、肺炎和烧伤的成年患者参加了这项研究。肺炎亚组包括150人(62%为男性,平均年龄- 41.3岁,33%伴有某些疾病)。纳入标准如下:年龄- 18-60岁,社区获得性肺炎和抗生素治疗,不迟于疾病开始后48小时给药,根据PSI/PORT指数至少为IV级,存在知情同意,SOFA基线水平≥2。在治疗第3天根据SOFA量表与基线水平进行的评估是主要终点。次要终点包括其他量表(APACHE II、SAPS II、MODS、PSI/PORT、CURB-65)平均结果的变化以及内源性中毒的生化、免疫学和积分指标的变化。结果和讨论。Reosorbilact辅助输注治疗(200- 400ml / d)可使循环血容量增加,总输注量减少,且无容量过载风险。其中一种可吸收成分乳酸不增加内源性乳酸水平,证明其安全性高。在联合治疗的3天内,Reosorbilact使体温从39.37°降至36.77°С,心率从105.27°降至77.81 bpm,白细胞数量从9.38°降至6.64×109/L。治疗第3天血氧合升高,PSI/PORT指数由101.47降至49.07。所有患者均未发现肺水肿或胸腔积液。结论:1。肺炎是一种广泛传播的疾病,通常需要住院治疗。2. 在Reosorbilact的帮助下,输液治疗增加了循环血容量,而没有容量过载的风险。3.在肺炎联合治疗的3天内加入吸附剂可使患者体温、心率、白细胞数量下降,血氧含量升高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rheo-STAT project. New options of the intoxication syndrome therapy from the point of view of the evidence: accent on pneumonia
Background. Pneumonia is a widespread disease and an often cause of hospitalizations both in Vietnam and Georgia. The supportive treatment of pneumonias includes the respiratory support, the support of fluid and electrolyte balance, parenteral nutrition and some additional drugs (analgesics, corticosteroids, inotropes). Rheo-STAT study is an interventional open-label randomized controlled study of Reosorbilact (“Yuria-Pharm”) effectiveness in pneumonia treatment. The study was held in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan). Objective. To assess Reosorbilact effectiveness in the elimination of the intoxication syndrome. Materials and methods. 628 adult patients with sepsis, peritonitis, pneumonias and burns took part in this study. The pneumonia subgroup included 150 people (62 % males, mean age – 41.3 years, 33 % had some concomitant diseases). Inclusion criteria were the following: age – 18-60 years, community-acquired pneumonia and antibiotic therapy, administered not later than after 48 hours after the disease beginning, at least IV class according to PSI/PORT index, the presence of informed consent, baseline level of SOFA points ≥2. The assessment according to the SOFA scale on the 3rd day of treatment in comparison to the baseline level was the primary endpoint. Secondary endpoints included the change of mean result according to other scales (APACHE II, SAPS II, MODS, PSI/PORT, CURB-65) and changes of biochemical, immunological and integral markers of endogenous intoxication. Results and discussion. Infusion therapy with the help of Reosorbilact (200-400 ml per day) led to the increase of circulating blood volume and to the decrease of total infusion volume without any risk of volume overload. Lactate – one of the Reosorbilact components – did not increase the endogenous lactate level, which testifies a high safety. Inclusion of Reosorbilact into the combined treatment in 3 days led to the body temperature decrease from 39.37 to 36.77 °С, heart rate decrease from 105.27 to 77.81 bpm, leucocytes amount – from 9.38 to 6.64×109/L. Blood oxygenation also increased at the 3rd day of treatment, and PSI/PORT index decreased from 101.47 to 49.07. Pulmonary edema or pleural effusion were not revealed in any patients. Conclusions. 1. Pneumonia is a widespread disease, which often requires hospitalization. 2. Infusion therapy with the help of Reosorbilact increases the circulating blood volume without a risk of volume overload. 3. Inclusion of Reosorbilact into the combined treatment of pneumonia in 3 days leads to the decrease of body temperature, heart rate, leucocyte amount and to the increase of blood oxigenation.
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