College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
J Crit Care. 2022 Dec;72:154121. doi: 10.1016/j.jcrc.2022.154121. Epub 2022 Jul 28.
To evaluate the outcomes of patients with septic shock treated with a combination of norepinephrine with phenylephrine compared to norepinephrine with vasopressin.
This was a retrospective cohort study including adults admitted between 2002 and 2017 with septic shock according to the Sepsis 3 criteria. We compared outcomes of patients treated with norepinephrine with phenylephrine to those treated with norepinephrine with vasopressin. Multivariate analysis was carried out to evaluate the association of norepinephrine with phenylephrine compared to norepinephrine with vasopressin with in-hospital mortality.
During the study period, 158 patients with septic shock were treated with norepinephrine with phenylephrine and 129 with norepinephrine with vasopressin. Crude in-hospital mortality was not different between the two groups [91/158 (57.6%) versus 80/129 (62.5%), p = 0.40]. There was also no difference in ICU length of stay or hospital length of stay. Multivariate analysis demonstrated no significant association of norepinephrine with phenylephrine with in-hospital mortality compared to norepinephrine with vasopressin (OR 0.62 (95% confidence interval 0.31, 1.23, p = 0.17).
Phenylephrine used as a second-line vasoactive agent combined with norepinephrine may be a reasonable option compared to vasopressin. However, this finding needs to be validated in a randomized controlled trial.
评估与去甲肾上腺素联合血管加压素相比，去甲肾上腺素联合苯肾上腺素治疗感染性休克患者的结局。
这是一项回顾性队列研究，纳入了 2002 年至 2017 年期间根据 Sepsis 3 标准诊断为感染性休克的成年患者。我们比较了使用去甲肾上腺素联合苯肾上腺素治疗的患者与使用去甲肾上腺素联合血管加压素治疗的患者的结局。进行多变量分析，以评估与去甲肾上腺素联合血管加压素相比，去甲肾上腺素联合苯肾上腺素与院内死亡率的相关性。
在研究期间，有 158 例感染性休克患者使用去甲肾上腺素联合苯肾上腺素治疗，129 例使用去甲肾上腺素联合血管加压素治疗。两组患者的院内死亡率无差异[91/158（57.6%）与 80/129（62.5%），p=0.40]。两组患者 ICU 住院时间和住院时间也无差异。多变量分析表明，与去甲肾上腺素联合血管加压素相比，去甲肾上腺素联合苯肾上腺素与院内死亡率无显著相关性（OR 0.62（95%置信区间 0.31, 1.23，p=0.17）。
与血管加压素相比，将苯肾上腺素作为二线血管活性药物与去甲肾上腺素联合使用可能是一种合理的选择。但是，这一发现需要在随机对照试验中得到验证。
