文献检索文档翻译深度研究
Suppr Zotero 插件Zotero 插件
邀请有礼套餐&价格历史记录

新学期,新优惠

限时优惠:9月1日-9月22日

30天高级会员仅需29元

1天体验卡首发特惠仅需5.99元

了解详情
不再提醒
插件&应用
Suppr Zotero 插件Zotero 插件浏览器插件Mac 客户端Windows 客户端微信小程序
高级版
套餐订阅购买积分包
AI 工具
文献检索文档翻译深度研究
关于我们
关于 Suppr公司介绍联系我们用户协议隐私条款
关注我们

Suppr 超能文献

核心技术专利:CN118964589B侵权必究
粤ICP备2023148730 号-1Suppr @ 2025

超越液体疗法:维生素C、类固醇和硫胺素在脓毒症管理中的作用

Beyond Fluid Therapy: The Role of Vitamin C, Steroids, and Thiamine in Sepsis Management.

作者信息

Idahor Courage O, Ogunfuwa Olamide, Ogbonna Ndidiamaka, Adigwe Augustina, Ogbeide Omo A

机构信息

Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham, GBR.

Emergency Medicine, Sandwell and West Birmingham NHS Trust, Birmingham, GBR.

出版信息

Cureus. 2025 May 23;17(5):e84666. doi: 10.7759/cureus.84666. eCollection 2025 May.


DOI:10.7759/cureus.84666
PMID:40546532
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12182648/
Abstract

Sepsis remains a major contributor to mortality among critically ill patients, with sepsis-induced metabolic dysfunction significantly worsening outcomes. As metabolic dysfunction plays a key role in the pathogenesis of sepsis, recent interest has grown around metabolic resuscitation therapies as potential adjuncts to traditional fluid resuscitation strategies. This narrative review evaluates current evidence regarding the role of vitamin C, thiamine, and corticosteroids in improving sepsis outcomes. Early studies suggested that vitamin C may reduce organ dysfunction and vasopressor requirements; however, more recent randomized trials have produced inconsistent results, with some findings even indicating potential harm in certain patient groups. Similarly, the use of corticosteroids in sepsis management has shown mixed outcomes. Thiamine has demonstrated possible renal protective effects and improved lactate clearance, although its impact on mortality and vasopressor needs remains inconclusive. Combination therapy with hydrocortisone, vitamin C, and thiamine (the HAT protocol) has been associated with reduced vasopressor duration but has not consistently improved survival or other major clinical endpoints, despite its apparent safety. Overall, while vitamin C, corticosteroids, and thiamine present a theoretically attractive strategy in sepsis management, clinical results remain debated. Corticosteroids currently have the strongest supporting evidence for use in septic shock, while vitamin C and thiamine remain investigational therapies and are not recommended for routine use outside clinical trials. Future research should explore biomarker-guided, precision-medicine approaches to better identify patients who might benefit most from metabolic resuscitation, and large-scale randomized controlled trials are needed to clarify optimal timing and dosing strategies.

摘要

脓毒症仍然是危重症患者死亡的主要原因,脓毒症诱导的代谢功能障碍会显著恶化预后。由于代谢功能障碍在脓毒症发病机制中起关键作用,近年来,作为传统液体复苏策略的潜在辅助手段,代谢复苏疗法受到了越来越多的关注。本叙述性综述评估了关于维生素C、硫胺素和皮质类固醇在改善脓毒症预后方面作用的现有证据。早期研究表明,维生素C可能减少器官功能障碍并降低血管活性药物的需求;然而,最近的随机试验结果并不一致,一些研究结果甚至表明在某些患者群体中可能存在潜在危害。同样,在脓毒症治疗中使用皮质类固醇的结果也喜忧参半。硫胺素已显示出可能的肾脏保护作用并改善了乳酸清除率,但其对死亡率和血管活性药物需求的影响仍不确定。氢化可的松、维生素C和硫胺素联合治疗方案(HAT方案)与血管活性药物使用时间缩短有关,尽管其安全性良好,但并未持续改善生存率或其他主要临床终点。总体而言,虽然维生素C、皮质类固醇和硫胺素在脓毒症治疗中提出了一种理论上有吸引力的策略,但临床结果仍存在争议。目前,皮质类固醇在感染性休克治疗中的使用证据最为充分,而维生素C和硫胺素仍为试验性治疗方法,不建议在临床试验之外常规使用。未来的研究应探索基于生物标志物的精准医学方法,以更好地识别可能从代谢复苏中获益最大的患者,并且需要大规模随机对照试验来阐明最佳时机和给药策略。

相似文献

[1]
Beyond Fluid Therapy: The Role of Vitamin C, Steroids, and Thiamine in Sepsis Management.

Cureus. 2025-5-23

[2]
Single-incision sling operations for urinary incontinence in women.

Cochrane Database Syst Rev. 2017-7-26

[3]
Home treatment for mental health problems: a systematic review.

Health Technol Assess. 2001

[4]
Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.

Cochrane Database Syst Rev. 2017-10-24

[5]
Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients.

Cochrane Database Syst Rev. 2018-6-25

[6]
EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer: 2006 update.

Eur J Cancer. 2007-1

[7]
Systemic treatments for metastatic cutaneous melanoma.

Cochrane Database Syst Rev. 2018-2-6

[8]
Effectiveness and safety of vitamin D in relation to bone health.

Evid Rep Technol Assess (Full Rep). 2007-8

[9]
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.

Crit Care Med. 2004-3

[10]
The Use of Hydrocortisone, Ascorbic Acid and Thiamine in Patients with Sepsis and Septic Shock - A Systematic Review.

J Pharm Pract. 2023-8

本文引用的文献

[1]
Mitochondrial dysfunction in sepsis: mechanisms and therapeutic perspectives.

Crit Care. 2024-9-3

[2]
Clinical Utility of Recently Food and Drug Administration-Approved IntelliSep Test (Sepsis Biomarker) for Early Diagnosis of Sepsis: Comparison with Other Biomarkers.

J Clin Med. 2024-8-16

[3]
From Molecular Mechanisms to Clinical Therapy: Understanding Sepsis-Induced Multiple Organ Dysfunction.

Int J Mol Sci. 2024-7-16

[4]
Nicotinamide mononucleotide as a therapeutic agent to alleviate multi-organ failure in sepsis.

J Transl Med. 2023-12-6

[5]
Immunopathophysiology of human sepsis.

EBioMedicine. 2022-12

[6]
Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit.

N Engl J Med. 2022-6-23

[7]
Mitochondrial autophagy: molecular mechanisms and implications for cardiovascular disease.

Cell Death Dis. 2022-5-9

[8]
Pathophysiology, mechanisms, and managements of tissue hypoxia.

Anaesth Crit Care Pain Med. 2022-8

[9]
The Effects of a Meldonium Pre-Treatment on the Course of the LPS-Induced Sepsis in Rats.

Int J Mol Sci. 2022-2-21

[10]
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.

Crit Care Med. 2021-11-1

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

推荐工具

医学文档翻译智能文献检索