Galley H F, Howdle P D, Walker B E, Webster N R
Academic Unit of Anaesthesia & Intensive Care, University of Aberdeen, UK.
Free Radic Biol Med. 1997;23(5):768-74. doi: 10.1016/s0891-5849(97)00059-2.
Oxidative stress is implicated in septic shock. We investigated the effect of intravenous antioxidant therapy on antioxidant status, lipid peroxidation, hemodynamics and nitrite in patients with septic shock. Thirty patients randomly received either antioxidants (n-acetylcysteine 150 mg/kg for 30 min then 20 mg/kg/h plus bolus doses of 1 g ascorbic acid and 400 mg alpha-tocopherol) or 5% dextrose. Basal vitamin C was low and redox-reactive iron was elevated in all patients. In the 16 patients receiving antioxidants, vitamin C increased (p = .0002) but total antioxidant capacity was unaffected. Lipid peroxides were elevated in all patients but did not increase further in the patients receiving antioxidants. Plasma total nitrite also increased (p = .007) in the antioxidant group. Heart rate increased in patients receiving antioxidants at 60 min (p = .018) and 120 min (p = .004). Cardiac index also increased at 60 min (p = .007) and 120 min (p = .05). Systemic vascular resistance index decreased at 120 min in the antioxidant treated patients (p = .003). The effect of antioxidants on hemodynamic variables has not previously been reported. Antioxidant administration may be a useful adjunct to conventional approaches in the management of septic shock.
氧化应激与脓毒性休克有关。我们研究了静脉注射抗氧化剂疗法对脓毒性休克患者抗氧化状态、脂质过氧化、血流动力学和亚硝酸盐的影响。30名患者随机接受抗氧化剂治疗（n-乙酰半胱氨酸150mg/kg，持续30分钟，然后20mg/kg/小时，加推注剂量1g抗坏血酸和400mgα-生育酚）或5%葡萄糖。所有患者基础维生素C水平低，氧化还原活性铁升高。在接受抗氧化剂治疗的16名患者中，维生素C增加（p = 0.0002），但总抗氧化能力未受影响。所有患者脂质过氧化物均升高，但接受抗氧化剂治疗的患者未进一步升高。抗氧化剂组血浆总亚硝酸盐也增加（p = 0.007）。接受抗氧化剂治疗的患者在60分钟（p = 0.018）和120分钟（p = 0.004）时心率增加。心脏指数在60分钟（p = 0.007）和120分钟（p = 0.05）时也增加。抗氧化剂治疗的患者在120分钟时全身血管阻力指数下降（p = 0.003）。抗氧化剂对血流动力学变量的影响此前未见报道。抗氧化剂给药可能是脓毒性休克常规治疗方法的有用辅助手段。
