摘要

Importance:Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS).
Objective:To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS.
Design, Setting, and Participants:The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018.
Interventions:Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours.
Main Outcomes and Measures:The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours.
Results:Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, -0.10; 95% CI, -1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 μg/mL; difference, 7.94 μg/mL; 95% CI, -8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, -2.8 to 4.2; P = .70) at 168 hours.
Conclusions and Relevance:In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS.
Trial Registration:ClinicalTrials.gov Identifier: NCT02106975.

译文

重要性: 实验数据表明,静脉注射维生素c 可以减轻与败血症和急性呼吸窘迫综合征 (ARDS) 相关的炎症和血管损伤。
目的: 确定静脉输注维生素c 对败血症和急性呼吸窘迫综合征 (ARDS) 患者器官功能衰竭评分及炎症和血管损伤生物学指标的影响。
设计、背景和参与者: CITRIS-ALI 试验是一项在美国 7 个医疗重症监护病房进行的随机、双盲、安慰剂对照的多中心试验, 登记患有败血症和 ARDS 的患者 (n = 167) 少于 24 小时。该研究于 2014年9月至 2017年11月进行,最终随访时间为 2018年1月。
干预: 患者被随机分配接受静脉注射维生素c (50 毫克/千克葡萄糖 5% 在水中,n = 84) 或安慰剂 (仅在水中葡萄糖 5%, n   = 83) 每 6 小时 96 小时。
主要结果和措施: 主要结果是通过改良的序贯器官衰竭评估评分 (范围,0-20,分数越高表明功能障碍越多) 来评估器官衰竭的变化从基线到 96 小时,在 0 时测量炎症 (C 反应蛋白水平) 和血管损伤 (血栓调节蛋白水平) 的血浆生物标志物,48 、 96 和 168 小时。
结果: 在 167 名随机患者中 (平均 [SD] 年龄,54.8 岁 [16.7]; 90 名男性 [54%]),103 (62%) 完成了天的研究。维生素 C 组和安慰剂组在平均改良序贯器官衰竭评估评分从基线到 96 小时的变化的主要终点上没有显著差异 (维生素从 9.8 到 6.8 C 组 [3 分] 和从 10.3 到 6.8 在安慰剂组 [3.5 分];差,-0.10; 95% CI,-1.23 到 1.03; p   =  。 86) 或在 C 反应蛋白水平 (54.1 vs 46.1 μ g/mL; 差,7.94 μ g/mL; 95% CI,-8.2 至 24.11; p ¼ = ¼。 33) 和血栓调节蛋白水平 (14.5 vs 13.8 纳克/毫升; 差,0.69 纳克/毫升; 95% CI,-2.8 至 4.2;P   = 70.70) 在 168 小时。
结论和相关性: 在这项对败血症和 ARDS 患者的初步研究中, 与安慰剂相比,96 小时的维生素c 输注并没有显著改善器官功能障碍评分或改变炎症和血管损伤的标记。需要进一步的研究来评估维生素c 在败血症和 ARDS 的其他结果中的潜在作用。
试验注册: ClinicalTrials.gov 标识符: nct02106975。

respiratory failure

呼吸 肺通气和(或)换气功能严重障碍 疾病
概述  :  

呼吸衰竭是指各种原因引起的肺通气和(或)换气功能严重障碍,使静息状态下亦不能维持足够的气体交换,导致低氧血症伴(或不伴)高碳酸血症,进而引起一系列病理生理改变和相应临床表现的综合征。其临床表现缺乏特异性,明确诊断有赖于动脉血气分析:在海平面、静息状态呼吸空气条件下,动脉血氧分压(PaO2)<60mmHg,伴或不伴二氧化碳分压(PaCO2)>50mmHg,可诊断为呼吸衰竭。 病因 完整的呼吸过程由相互衔接且同时进行的

Respiratory   /ˈrespərətɔːri/ 

释    义   adj. 呼吸的

同根词   respiration n. 呼吸;呼吸作用

               respirator n. 口罩;[医] 呼吸器;防毒面具

               respire vi.呼吸

               respire vt.呼吸

例    句   The blocking of these receptors causes paralysis, respiratory failure and death. 这些受体的阻塞将会引起麻痹、呼吸衰竭和死亡。

 

Failure   /ˈfeɪljər/ 

释    义   n. 失败;故障;失败者;破产

同根词   failed adj.已失败的,不成功的

               failing adj. 失败的

               fail n.不及格;vt.不及格;使失望;忘记;舍弃;vi.失败,不及格;破产;缺乏;衰退

               failing n.失败;缺点,过失;弱点

例    句   Defeat and failure make people humble. 挫折与失败会使人谦卑。

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