NEJM：血压目标导向治疗在脓毒症休克患者的应用价值
http://www.ncbi.nlm.nih.gov/pubmed/24635770http://www.nejm.org/doi/full/10.1056/NEJMoa1312173
今日出版的NEJM杂志再次发表重量级研究，探讨关于血压目标导向治疗在脓毒症休克患者的应用价值。
结果发现，在脓毒症休克患者复苏治疗中，与设定MAP65-70mmHg的目标值相比，80-85mmHg的MAP目标并无显著益处，表现在28d或90d死亡率无差别。
N Engl J Med. 2014 Mar 18.
High versus Low Blood-Pressure Target in Patients with Septic Shock.Asfar P1, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Linden TV, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Hervé F, Cheyron DD, Guerin C,Mercat A, Teboul JL, Radermacher P; the SEPSISPAM Investigators.
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AbstractBackground The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. Methods In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). The primary end point was mortality at day 28. Results At 28 days, there was no significant between-group difference in mortality, with deaths reported in 142 of 388 patients in the high-target group (36.6%) and 132 of 388 patients in the low-target group (34.0%) (hazard ratio in the high-target group, 1.07; 95% confidence interval , 0.84 to 1.38; P=0.57). There was also no significant difference in mortality at 90 days, with 170 deaths (43.8%) and 164 deaths (42.3%), respectively (hazard ratio, 1.04; 95% CI, 0.83 to 1.30; P=0.74). The occurrence of serious adverse events did not differ significantly between the two groups (74 events and 69 events , respectively; P=0.64). However, the incidence of newly diagnosed atrial fibrillation was higher in the high-target group than in the low-target group. Among patients with chronic hypertension, those in the high-target group required less renal-replacement therapy than did those in the low-target group, but such therapy was not associated with a difference in mortality. Conclusions Targeting a mean arterial pressure of 80 to 85 mm Hg, as compared with 65 to 70 mm Hg, in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either 28 or 90 days. (Funded by the French Ministry of Health; SEPSISPAM ClinicalTrials.gov number, NCT01149278 .).
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拯救脓毒症患者行动-国际严重脓毒症和脓毒性休克治疗指南-2012
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