切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (03) : 189 -192. doi: 10.3877/cma.j.jssn.2096-1537.2016.03.011

所属专题: 重症医学 文献

观点

-反方观点-早期目标导向治疗:对降低病死率并无显著优势
李笑男, 张久之, 万献尧   
  • 收稿日期:2016-07-16 出版日期:2016-08-28
  • 通信作者: 万献尧
  • 基金资助:
    辽宁省自然科学基金(201102053); 大连市科技局项目(2012E15SF162); 辽宁省卫生厅项目(ZX201003); 中华医学会临床医学科研专项(10030140236)

Early goal directed therapy: has no superiority in decreasing mortality of sepsis

Xiaonan Li, Jiuzhi Zhang, Xianyao Wan   

  • Received:2016-07-16 Published:2016-08-28
  • Corresponding author: Xianyao Wan
  • About author:
    Corresponding author: Wan Xianyao, Email:
引用本文:

李笑男, 张久之, 万献尧. -反方观点-早期目标导向治疗:对降低病死率并无显著优势[J/OL]. 中华重症医学电子杂志, 2016, 02(03): 189-192.

Xiaonan Li, Jiuzhi Zhang, Xianyao Wan. Early goal directed therapy: has no superiority in decreasing mortality of sepsis[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(03): 189-192.

早期目标导向治疗(early goal directed therapy,EGDT)自2001年由Rivers等提出以来,一直被用于严重脓毒症与感染性休克的早期复苏,因其可显著提高危重患者的抢救成功率和改善预后而受到重症医学界的极大关注。近年来,随着EGDT在临床的广泛应用以及多项与之相关的高质量研究的发表,人们发现EGDT在降低病死率方面并无显著优势,甚至还会对患者产生不利影响。

Early goal directed therapy, proposed by Rivers in 2001, was extensively used for early resuscitation in patients with severe sepsis and septic shock. It has attracted a lot of attentions since it could improve resuscitation and prognosis of critical ill patients. However, we find that EGDT has no benefit in reducing mortality and might had some harmful effects on patients along with it widely used in clinical scenarios and the publishment of numerous high-quality researches on EGDT.

[1]
Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19):1368–1377.
[2]
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012[J]. Crit Care Med, 2013, 41(2):580–637.
[3]
Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock[J]. Intensive Care Med, 2004, 30(4):536–555.
[4]
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Intensive Care Med, 2008, 34(1):17–60.
[5]
ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock[J]. N Engl J Med, 2014, 370(18):1683–1693.
[6]
ARISE Investigators, Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock[J]. N Engl J Med, 2014, 371(16):1496–1506.
[7]
ProMISe Trial Investigators, Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock[J]. N Engl J Med, 2015, 372(14):1301–1311.
[8]
Angus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators[J]. Intensive Care Med, 2015, 41(9):1549–1560.
[9]
Perner A, Myburgh J. Ten ′short-lived′ beliefs in intensive care medicine[J]. Intensive Care Med, 2015, 41(9):1703–1706.
[10]
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense[J]. Crit Care Med, 2013, 41(7):1774–1781.
[11]
Marik PE. Iatrogenic salt water drowning and the hazards of a high central venous pressure[J]. Ann Intensive Care, 2014, 4(1):1–9.
[12]
Marik PE. The physiology of volume resuscitation[J]. Curr Anesthesiol Rep, 2014, 4(4):353–359.
[13]
Vellinga NA, Ince C, Boerma EC. Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis[J]. BMC Anesthesiol, 2013, 13:17.
[14]
Legrand M, Dupuis C, Simon C, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study[J]. Crit Care, 2013, 17(6):R278.
[15]
Kelm DJ, Perrin JT, Cartin-Ceba R, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death[J]. Shock, 2015, 43(1):68–73.
[16]
Levy MM, Fink MP, Marshall JC, et al. International sepsis definitions conference[J]. Crit Care Med, 2003, 31(4):1250–1256.
[17]
万献尧, 黄伟. 对国际上有关全身性感染诊断标准与治疗指南的一些看法[J]. 中华内科杂志, 2007, 46(9):709.
[18]
Fuller BM, Gajera M, Schorr C, et al. The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy[J]. Indian J Crit Care Med, 2010, 14(4):165–169.
[19]
Marik PE, Varon J. Early goal-directed therapy: on terminal life support?[J]. Am J Emerg Med, 2010, 28(2):243–245.
[20]
Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock[J]. N Engl J Med, 2014, 371(15):1381–1391.
[21]
Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature[J]. Crit Care Med, 2008, 36(9):2667–2674.
[22]
Hayes MA, Timmins AC, Yau EH, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients[J]. N Engl J Med, 1994, 330(24):1717–1722.
[23]
Bouferrache K, Amiel JB, Chimot L, et al. Initial resuscitation guided by the Surviving Sepsis Campaign recommendations and early echocardiographic assessment of hemodynamics in intensive care unit septic patients: a pilot study[J]. Crit Care Med, 2012, 40(10):2821–2827.
[24]
Sharawy N, Lehmann C. New directions for sepsis and septic shock research[J]. J Surg Res, 2015, 194(2):520–527.
[25]
李笑男, 张久之, 万献尧. 严重脓毒症及感染性休克早期目标导向治疗之现状及相关问题[J]. 中华内科杂志, 2016, 55(6):486–489.
[1] 农云洁, 黄小桂, 黄裕兰, 农恒荣. 超声在多重肺部感染诊断中的临床应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 872-876.
[2] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[3] 刘欢, 邢皓, 常正奇, 张记. 机械敏感性离子通道蛋白Piezo1在感染相关疾病中的研究进展[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 263-269.
[4] 黄鸿初, 黄美容, 温丽红. 血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 285-292.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[7] 邹永康, 石雍, 徐贤刚, 张帅民, 刘衍, 杨生鹏, 叶啟发, 陈根, 张毅. 肾移植术后手术切口米根霉感染伴菌血症一例并文献复习[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 289-292.
[8] 皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[9] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[10] 臧宇, 姚胜, 朱新勇, 戎世捧, 田智超. 低温等离子射频消融治疗腹壁疝术后补片感染的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 687-692.
[11] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[12] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[13] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 董晟, 郎胜坤, 葛新, 孙少君, 薛明宇. 反向休克指数乘以格拉斯哥昏迷评分对老年严重创伤患者发生急性创伤性凝血功能障碍的预测价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 541-547.
阅读次数
全文


摘要