Collier Bryan R, Giladi Aviram, Dossett Lesly A, Dyer Lindsay, Fleming Sloan B, Cotton Bryan A
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):384-8. doi: 10.1177/0148607108319808.
The profound oxidative stress that occurs following injury results in significant depletion of many endogenous antioxidants (vitamin C, E, selenium). Increasing evidence suggests antioxidant supplementation reduces infectious complications and organ dysfunction following injury and hemorrhagic shock. The purpose of this study was to evaluate the impact of high-dose antioxidant administration on the mortality rate of acutely injured patients.
In October 2005, we implemented a 7-day high-dose antioxidant protocol for acutely injured patients admitted to our trauma center. A retrospective cohort study, evaluating all patients admitted to the trauma service between October 2005 and September 2006 following protocol implementation (AO+), was performed. The comparison cohort (AO-) was made up of those patients admitted in the year prior to protocol implementation.
A total of 4,294 patients met criteria (AO+, N = 2,272; AO-, N = 2022). Hospital (4 vs 3 days, P < .001) and ICU (3 vs 2 days, P = .001) median length of stays were significantly shorter in the AO+ group. Mortality was significantly lower in the AO+ group (6.1% vs 8.5%, P = .001), translating into a 28% relative risk reduction for mortality in patients exposed to high-dose antioxidants. After adjusting for age, gender, and probability of survival, AO exposure was associated with even lower mortality (OR 0.32, 95% CI 0.22-0.46). Patients with an expected survival <50% benefited most (OR 0.24, 95% CI 0.15-0.37).
A high-dose antioxidant protocol resulted in a 28% relative risk reduction in mortality and a significant reduction in both hospital and ICU length of stay. This protocol represents an inexpensive intervention to reduce mortality/morbidity in the trauma patient.
损伤后发生的严重氧化应激会导致许多内源性抗氧化剂（维生素C、E、硒）显著消耗。越来越多的证据表明，补充抗氧化剂可减少损伤和失血性休克后的感染并发症及器官功能障碍。本研究的目的是评估高剂量抗氧化剂给药对急性损伤患者死亡率的影响。
2005年10月，我们对入住我院创伤中心的急性损伤患者实施了为期7天的高剂量抗氧化剂方案。进行了一项回顾性队列研究，评估2005年10月至2006年9月按照该方案入院的所有创伤科患者（AO+）。对照队列（AO-）由方案实施前一年入院的患者组成。
共有4294例患者符合标准（AO+组，N = 2272；AO-组，N = 2022）。AO+组的医院中位住院时间（4天对3天，P <.001）和ICU中位住院时间（3天对2天，P =.001）显著缩短。AO+组的死亡率显著降低（6.1%对8.5%，P =.001），这意味着接受高剂量抗氧化剂治疗的患者死亡率相对风险降低了28%。在调整年龄、性别和生存概率后，AO暴露与更低的死亡率相关（OR 0.32，95%CI 0.22 - 0.46）。预期生存率<50%的患者受益最大（OR 0.24，95%CI 0.15 - 0.37）。
高剂量抗氧化剂方案使死亡率相对风险降低了28%，并显著缩短了医院和ICU的住院时间。该方案是一种降低创伤患者死亡率/发病率的低成本干预措施。
