Gozzoli Valerio, Treggiari Miriam M, Kleger Gian-Reto, Roux-Lombard Pascale, Fathi Marc, Pichard Claude, Romand Jacques-André
Surgical Intensive Care Division, University Hospital of Geneva, 1211 Geneva 14, Switzerland.
Intensive Care Med. 2004 Mar;30(3):401-7. doi: 10.1007/s00134-003-2087-2. Epub 2004 Jan 13.
We investigated the metabolic, hemodynamic, and inflammatory responses of pharmacological and physical therapies aimed at reducing body temperature in febrile critically ill patients.
Open-label, randomized trial in a surgical ICU in a tertiary university hospital.
Thirty analgosedated, mechanically ventilated patients with a temperature of 38.5 degrees C or higher were randomized to receive either intravenous metamizol, intravenous propacetamol, or external cooling.
Body temperature and metabolic and hemodynamic variables were recorded at baseline and during the following 4 h. Cytokine concentrations were assessed before and 4 and 12 h after the initiation of antipyresis. Body temperature decreased significantly in all treatment groups. For a 1 degrees C temperature decrease, the energy expenditure index increased by 5% with external cooling and decreased by 7% and 8% in the metamizol and propacetamol groups, respectively. Metamizol induced a significant decrease in mean arterial pressure and urine output compared to baseline and to the other two groups. C-reactive protein increased over time, but compared to the other groups it was significantly lower in patients receiving metamizol after 4 h. Cytokine concentrations were not different among the three groups or over time, although interleukin 6 tended to decrease over time in the metamizol group.
Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.
我们研究了旨在降低发热重症患者体温的药物治疗和物理治疗的代谢、血流动力学及炎症反应。
在一所三级大学医院的外科重症监护病房进行的开放标签随机试验。
30例接受镇痛镇静、机械通气且体温在38.5摄氏度或更高的患者被随机分组，分别接受静脉注射安乃近、静脉注射丙帕他莫或外部降温治疗。
在基线及随后4小时记录体温、代谢和血流动力学变量。在开始退热治疗前、治疗后4小时和12小时评估细胞因子浓度。所有治疗组的体温均显著下降。体温每降低1摄氏度，外部降温组的能量消耗指数增加5%，安乃近组和丙帕他莫组分别降低7%和8%。与基线及其他两组相比，安乃近导致平均动脉压和尿量显著下降。C反应蛋白随时间增加，但与其他组相比，接受安乃近治疗4小时后的患者C反应蛋白显著更低。三组之间或随时间变化，细胞因子浓度无差异，尽管安乃近组白细胞介素6随时间有下降趋势。
安乃近、丙帕他莫和外部降温在降低体温方面效果相同。考虑到不良的血流动力学效应，在不稳定患者中，安乃近不应被视为首选的退热药物。应优先选择丙帕他莫或外部降温，不过对于不太可能耐受外部降温引起的代谢需求增加的患者，应避免使用外部降温。
