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]. 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]. 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] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[2] 姚咏明. 如何精准评估烧伤脓毒症患者免疫状态[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 552-552.
[3] 涂家金, 廖武强, 刘金晶, 涂志鹏, 毛远桂. 严重烧伤患者鲍曼不动杆菌血流感染的危险因素及预后分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 491-497.
[4] 杨瑞洲, 李国栋, 吴向阳. 腹股沟疝术后感染的治疗方法探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 715-719.
[5] 徐金林, 陈征. 抗菌药物临床应用监测对腹股沟疝修补术预防用药及感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 720-723.
[6] 李静如, 王江玲, 吴向阳. 简易负压引流在腹股沟疝术后浅部感染中的疗效分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 745-749.
[7] 李秉林, 吕少诚, 潘飞, 姜涛, 樊华, 寇建涛, 贺强, 郎韧. 供肝灌注液病原菌与肝移植术后早期感染的相关性分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 656-660.
[8] 赵立力, 王魁向, 张小冲, 李志远. 血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 351-355.
[9] 卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[10] 李静静, 翟蕾, 赵海平, 郑波. 多囊肾合并囊肿的多重耐药菌感染一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 920-923.
[11] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[12] 卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.
[13] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[14] 谭睿, 王晶, 於江泉, 郑瑞强. 脓毒症中高密度脂蛋白、载脂蛋白A-I和血清淀粉样蛋白A的作用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(06): 749-753.
[15] 杨艳丽, 陈昱, 赵若辰, 杜伟, 马海娟, 许珂, 张莉芸. 系统性红斑狼疮合并血流感染的危险因素及细菌学分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 694-699.
阅读次数
全文


摘要