危重手术患者输注晶体与胶体后发病率和死亡率对比一项随机试验的亚.PDFVIP

危重手术患者输注晶体与胶体后发病率和死亡率对比：一项 随机试验的亚组分析 Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients：A Subgroup Analysis of a Randomized Trial 摘要翻译; 背景:危重病人(CRISTAL)复苏的多中心随机胶体和晶体试验旨在测试在重症监护病房低血容 量休克患者复苏过程中，胶体与晶体相比是否改变了死亡率。在手术患者亚组中这项预先 计划的分析结果验证了同样的假设。 方法:CRISTAL 试验前瞻性地将危重外科患者的标准定为——在重症监护病房入院前或入院 后24 小时内接受紧急或择期手术并伴低血容量休克。主要的测量指标是28 天内死亡情况。 次要指标包括90 天内死亡情况、需要肾脏替代治疗或需要新鲜冷冻血浆输血。 结果:危重手术患者741 例，晶体 356例，胶体 385 例。年龄中位数(四分位数范围)为 66 岁(52 岁至76 岁)，484 名(65.3%)患者为男性。543 例(73.3%)未安排手术。到第28 天， 晶体组死亡84 例(23.6%)和胶体组死亡100 例(26%)，死亡率没有显著差异;调整优势比 0.86;95% CI, 0.61 ~ 1.21;P = 0.768) 。90 天死亡情况(111 例[31.2%]对122 例[31.7%]);调整优势 比0.97;95% CI, 0.70-1.33;P = 0.919),各组间差异无统计学意义。晶体 42 例(11.8%)患者需要 肾脏替代治疗，胶体 49 例(12.7%)患者需要肾脏替代治疗(P = 0.871) 。 结论:作者发现在危重手术患者中，晶体和胶体相比并没有提高生存率。 原文摘要： Background: The multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. This preplanned analysis tested the same hypothesis in the subgroup of surgical patients. Methods: The CRISTAL trial prospectively defined patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24 h of intensive care unit admission and had hypovolemic shock. The primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion. Results: There were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not