Rhodes Andrew, Cusack Rebecca J, Newman Philip J, Grounds R Michael, Bennett E David
Department of Intensive Care, St George's Hospital, London SW17 0QT, UK.
Intensive Care Med. 2002 Mar;28(3):256-64. doi: 10.1007/s00134-002-1206-9. Epub 2002 Feb 13.
To compare the survival and clinical outcomes of critically ill patients treated with the use of a pulmonary artery catheter (PAC) to those treated without the use of a PAC.
Prospective, randomised, controlled, clinical trial from October 1997 to February 1999.
Adult intensive care unit at a large teaching hospital.
Two hundred one critically ill patients were randomised either to a PAC group ( n=95) or the control group ( n=106). One patient in the control group was withdrawn from the study and five patients in the PAC group did not receive a PAC. All participants were available for follow-up.
Participants were assigned to be managed either with the use of a PAC (PAC group) or without the use of a PAC (control group).
Survival to 28 days, intensive care and hospital length of stay and organ dysfunction were compared on an intention-to-treat basis and also on a subgroup basis for those participants who successfully received a PAC. RESULTS There was no significant difference in mortality between the PAC group [46/95 (47.9%)] and the control group [50/106 (47.6)] (95% confidence intervals for the difference -13 to 14%, p>0.99). The mortality for participants who had management decisions based on information derived from a PAC was 41/91 (45%, 95% confidence intervals -11 to 16%, p=0.77). The PAC group had significantly more fluids in the first 24 h (4953 (3140, 7000) versus 4292 (2535, 6049) ml) and an increased incidence of renal failure (35 versus 20% of patients at day 3 post randomisation p<0.05) and thrombocytopenia ( p<0.03).
These results suggest that the PAC is not associated with an increased mortality.
比较使用肺动脉导管（PAC）治疗的重症患者与未使用PAC治疗的患者的生存率和临床结局。
1997年10月至1999年2月的前瞻性、随机、对照临床试验。
一家大型教学医院的成人重症监护病房。
201例重症患者被随机分为PAC组（n = 95）或对照组（n = 106）。对照组中有1例患者退出研究，PAC组中有5例患者未接受PAC。所有参与者均可供随访。
参与者被分配接受使用PAC管理（PAC组）或不使用PAC管理（对照组）。
在意向性治疗基础上，以及对成功接受PAC的参与者按亚组进行比较，比较28天生存率、重症监护和住院时间以及器官功能障碍情况。结果PAC组[46/95（47.9%）]和对照组[50/106（47.6%）]的死亡率无显著差异（差异的95%置信区间为-13%至14%，p>0.99）。根据PAC获得的信息做出管理决策的参与者的死亡率为41/91（45%，95%置信区间为-11%至16%，p = 0.77）。PAC组在最初24小时内输注的液体显著更多（4953（3140，7000）毫升对4292（2535，6049）毫升），肾衰竭发生率增加（随机分组后第3天患者中分别为35%对20%，p<0.05），血小板减少症发生率增加（p<0.03）。
这些结果表明，PAC与死亡率增加无关。
