Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
J Intensive Care Med. 2020 Dec;35(12):1383-1388. doi: 10.1177/0885066618823152. Epub 2019 Jan 13.
Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in intermittent and continuous infusion with the objective of developing the infusion regimen and optimizing the timing.
A prospective, randomized clinical trial was designed to compare the antioxidative effect of NAC in intermittent infusion group (IV: 25 mg/kg bolus and then 25 mg/kg/8 hours 3 times) and continuous infusion group (IV: 25 mg/kg bolus and then 75 mg/kg over 24 hours) in 60 critically ill patients with sepsis (20 patients in each group). Blood samples were collected immediately before and after intervention for total antioxidant capacity (TAC) and malondialdehyde (MDA) assessment.
N-acetyl cysteine considerably increased TAC levels in both intermittent (0.68 ± 0.60; value = .036) and continuous (0.69 ± 0.64; value = .015) infusion groups when compared to placebo (0.61 ± 0.10); however, the difference in TAC levels between the intermittent and the continuous infusion did not reach statistical significance ( value = .942). Likewise, NAC treatment decreased MDA levels in both intermittent (19.45 ± 4.18; value = 0.001) and continuous (22.47 ± 6.68; value = .002) infusion groups when compared to placebo (31.76 ± 11.06), while the difference in MDA levels between the intermittent and the continuous infusion did not reach statistical significance ( value = .481).
Our data confirmed the antioxidative effect of NAC treatment in patients with sepsis, with no significant difference in intermittent and continuous infusion.
关于 N-乙酰半胱氨酸（NAC）在脓毒症治疗中的疗效存在相互矛盾的结果。影响 NAC 在脓毒症治疗中疗效的关键因素是其输注的时间和剂量。我们旨在评估 NAC 对脓毒症患者氧化还原状态的影响，并比较间歇输注和连续输注的疗效，旨在制定输注方案并优化时机。
设计了一项前瞻性、随机临床试验，以比较 NAC 在间歇输注组（IV：25mg/kg 推注，然后 25mg/kg/8 小时 3 次）和连续输注组（IV：25mg/kg 推注，然后 75mg/kg 持续 24 小时）中的抗氧化作用在 60 名患有脓毒症的危重病患者（每组 20 名患者）。在干预前后立即采集血液样本，用于总抗氧化能力（TAC）和丙二醛（MDA）评估。
与安慰剂（0.61 ± 0.10）相比，N-乙酰半胱氨酸可显著提高间歇输注（0.68 ± 0.60； 值 =.036）和连续输注（0.69 ± 0.64； 值 =.015）组的 TAC 水平，但间歇输注和连续输注之间的 TAC 水平差异没有达到统计学意义（ 值 =.942）。同样，与安慰剂（31.76 ± 11.06）相比，NAC 治疗可降低间歇输注（19.45 ± 4.18； 值 = 0.001）和连续输注（22.47 ± 6.68； 值 = 0.002）组的 MDA 水平，而间歇输注和连续输注之间的 MDA 水平差异没有达到统计学意义（ 值 =.481）。
我们的数据证实了 NAC 治疗脓毒症患者的抗氧化作用，间歇输注和连续输注之间没有显著差异。
