Langlois P L, de Oliveira Figliolino L F, Hardy G, Manzanares W
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Hospital Municipal de Cubatão, São Paulo, Brasil.
Med Intensiva. 2014 Apr;38(3):173-80. doi: 10.1016/j.medin.2013.07.007. Epub 2013 Sep 8.
Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.
危重病的特征是氧化应激，这会导致多器官功能衰竭，而脓毒症相关器官功能障碍仍然是重症监护病房最常见的死亡原因。在过去20年里，已开发出不同的抗氧化疗法来改善脓毒症患者的预后。根据最近的证据，硒疗法应被视为抗氧化策略的基石。当以静脉推注形式给予负荷剂量时，以亚硒酸或亚硒酸钠形式给予的硒应被视为具有促氧化和细胞毒性作用的药物或营养药物，尤其是在严重脓毒症/脓毒性休克的早期阶段。迄今为止，多项II期试验已证明，硒疗法可能能够降低重症脓毒症患者的死亡率、改善器官功能障碍并减少感染。硒疗法在脓毒症综合征中的效果必须通过大型、设计良好的III期临床试验来证实。本综述的目的是讨论脓毒症综合征中硒营养药理学的当前证据。
