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重新评估败血症和感染性休克中的维生素C：对重症病例有潜在益处？

Reevaluating vitamin C in sepsis and septic shock: a potential benefit in severe cases?

作者信息

Alissa Abdulrahman, Alrashed Mohammed A, Alshaya Abdulrahman I, Al Sulaiman Khalid, Alharbi Shmeylan

机构信息

Pharmaceutical Care Services, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.

College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

出版信息

Front Med (Lausanne). 2024 Oct 29;11:1476242. doi: 10.3389/fmed.2024.1476242. eCollection 2024.

DOI:10.3389/fmed.2024.1476242
PMID:39540046
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11558524/
Abstract

Vitamin C (Ascorbic acid) has evolved as an emergent co-intervention for sepsis and septic shock patients. Multiple studies discussed the pathophysiological value of vitamin C to reserve endothelial functionality and improve microcirculatory flow in these patients. Nevertheless, most randomized clinical trials failed to show the clinical impact of adding vitamin C to sepsis and septic shock. Pneumonia is the most common infection to induce sepsis and septic shock, which could be an acute respiratory distress syndrome. Preliminary data support the role of vitamin C in mitigating the risk of acute respiratory distress syndrome (ARDS) development. This review aims to compare and contrast these trials and explore differences in their patients' populations, methodologies, and outcomes, emphasizing pneumonia-induced sepsis and septic shock.

摘要

维生素C（抗坏血酸）已成为脓毒症和脓毒性休克患者一种新出现的联合干预措施。多项研究探讨了维生素C在这些患者中保留内皮功能和改善微循环血流的病理生理价值。然而，大多数随机临床试验未能显示在脓毒症和脓毒性休克治疗中添加维生素C的临床效果。肺炎是诱发脓毒症和脓毒性休克最常见的感染，可能会发展为急性呼吸窘迫综合征。初步数据支持维生素C在降低急性呼吸窘迫综合征（ARDS）发生风险方面的作用。本综述旨在比较和对比这些试验，并探讨其患者群体、方法和结果的差异，重点关注肺炎诱发的脓毒症和脓毒性休克。

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Front Med (Lausanne). 2024 Oct 29;11:1476242. doi: 10.3389/fmed.2024.1476242. eCollection 2024.
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The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials.静脉注射维生素 C 治疗脓毒症或感染性休克患者的结局：一项随机对照试验的荟萃分析。
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Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock: The ACTS Randomized Clinical Trial.抗坏血酸、皮质类固醇和硫胺素对脓毒性休克器官损伤的影响：ACT 随机临床试验。
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Combination therapy of vitamin C and thiamine for septic shock: a multi-centre, double-blinded randomized, controlled study.维生素 C 和硫胺素联合治疗感染性休克的多中心、双盲随机对照研究。
Intensive Care Med. 2020 Nov;46(11):2015-2025. doi: 10.1007/s00134-020-06191-3. Epub 2020 Aug 11.
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Combined Treatment With Hydrocortisone, Vitamin C, and Thiamine for Sepsis and Septic Shock: A Randomized Controlled Trial.氢化可的松、维生素 C 和硫胺素联合治疗脓毒症和脓毒性休克：一项随机对照试验。
Chest. 2020 Jul;158(1):174-182. doi: 10.1016/j.chest.2020.02.065. Epub 2020 Mar 31.
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Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis: The ORANGES Trial.抗坏血酸、硫胺素和糖皮质激素用于脓毒症早期代谢复苏的结局：ORANGES 试验。
Chest. 2020 Jul;158(1):164-173. doi: 10.1016/j.chest.2020.02.049. Epub 2020 Mar 17.
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