补充牛磺酸对预防机械通气小儿呼吸机相关性肺炎的影响：一项随机对照双盲临床试验
Effect of taurine supplementation on preventing ventilator-associated pneumonia in pediatrics under mechanical ventilation, a randomized controlled double-blind clinical trial.
作者信息
Shirzad-Yazdi Nasrin, Shorafa Eslam, Abootalebi Seyedeh Narjes, Heidari Reza, Hojabri Katayoon, Doostfatemeh Marziyeh, Masjedi Fatemeh, Vazin Afsaneh, Shafiekhani Mojtaba
机构信息
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
出版信息
Front Pediatr. 2025 Jan 10;12:1490247. doi: 10.3389/fped.2024.1490247. eCollection 2024.
INTRODUCTION
One of the most prevalent healthcare-associated infections in the pediatric intensive care unit is ventilator-associated pneumonia (VAP). VAP not only results in prolonged hospital and intensive care unit (ICU) stays but also imposes higher costs on patients and the healthcare system. Therefore, it is essential to implement preventive measures. The lung-protective properties of taurine are recognized, and this research focuses on assessing the impact of taurine supplementation in preventing VAP.
METHOD
This double-blind, randomized clinical trial was conducted at Namazi Hospital's PICUs. The study included pediatrics on mechanical ventilation for over 48 h. Patients were randomly divided into two groups: the taurine and placebo groups. Alongside the standard care, participants from both groups were administered taurine or placebo capsules (30 mg/kg. day) in divided doses from the day of PICU admission through PICU discharge. The incidence of VAP through clinical and laboratory evidence was considered the primary outcome.
RESULTS
Seventy-seven patients were included in the study, with 38 in the taurine group and 39 in the placebo group. VAP incidence was 7.9% in the taurine group and 64.1% in the placebo group. Taurine significantly reduced the duration of mechanical ventilation, ICU and hospital stay, and inotrope duration. The occurrence of septic shock was lower in the taurine group at 5.3%. Stepwise logistic regression showed that placebo receipt was the only risk factor for VAP, with placebo recipients being 20.8 times more likely to develop VAP. ( < 0.0001, OR 20.8, 95% CI 6.11-97.93) Taurine treatment also significantly reduced inflammatory markers such as CRP, pro-calcitonin, and interleukin-6 compared to placebo.
CONCLUSION
Our results showed that taurine supplementation can reduce the incidence of VAP and the duration of mechanical ventilation, ICU, and hospital stay in critically ill pediatric patients.
REGISTRATION NUMBER OF THE CLINICAL TRIAL
This study received approval from the Iranian registry clinical trial, registered on 29 June 2023 (IRCT20120731010453N4, http://www.irct.ir/).
引言
小儿重症监护病房中最常见的医疗相关感染之一是呼吸机相关性肺炎（VAP）。VAP不仅会导致住院时间和重症监护病房（ICU）停留时间延长，还会给患者和医疗系统带来更高的成本。因此，实施预防措施至关重要。牛磺酸的肺保护特性已得到认可，本研究重点评估补充牛磺酸对预防VAP的影响。
方法
这项双盲、随机临床试验在纳马齐医院的儿科重症监护病房进行。该研究纳入了接受机械通气超过48小时的儿科患者。患者被随机分为两组：牛磺酸组和安慰剂组。除标准护理外，两组参与者从入住儿科重症监护病房之日起至出院，均按分剂量服用牛磺酸或安慰剂胶囊（30mg/kg·天）。通过临床和实验室证据确定的VAP发生率被视为主要结局。
结果
该研究共纳入77例患者，其中牛磺酸组38例，安慰剂组39例。牛磺酸组的VAP发生率为7.9%，安慰剂组为64.1%。牛磺酸显著缩短了机械通气时间、ICU停留时间和住院时间以及血管活性药物使用时间。牛磺酸组感染性休克的发生率较低，为5.3%。逐步逻辑回归显示，接受安慰剂是VAP的唯一危险因素，接受安慰剂者发生VAP的可能性是其他患者的20.8倍。（P<0.0001，OR 20.8，95%CI 6.11-97.93）与安慰剂相比，牛磺酸治疗还显著降低了炎症标志物如CRP、降钙素原和白细胞介素-6的水平。
结论
我们的结果表明，补充牛磺酸可以降低重症儿科患者VAP的发生率，并缩短机械通气时间、ICU停留时间和住院时间。
临床试验注册号
本研究获得伊朗临床试验注册批准，于2023年6月29日注册（IRCT20120731010453N4，http://www.irct.ir/）
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