氢化可的松、维生素C、硫胺素联合方案在脓毒症治疗中的争议与价值

The controversy and value of the combination of hydrocortisone,ascorbic acid and thiamine in treating sepsis

脓毒症是重症监护病房患者死亡的常见原因,有回顾性研究显示联合氢化可的松、维生素C、硫胺素(即HAT方案)可降低脓毒症及感染性休克患者的病死率,而近期多项随机对照试验(RCTs)结果并不统一。有荟萃分析显示,HAT方案可降低脓毒症及感染性休克患者病死率、改善序贯器官衰竭评分(SOFA评分)、减少血管活性药物使用,但在HAT方案的适应人群、启用时间、应用剂量、疗程、药物安全性等方面仍存在争议,需优化目前RCTs设计以提供更为确切的证据。

Sepsis is a common cause of death in intensive care unit.Some retrospective studies had shown the combination of hydrocortisone,ascorbic acid and thiamine(HAT therapy)could lower mortality rate of patients with sepsis or septic shock.Recently,multiple randomized controlled trials(RCTs)related to the efficacy of combination therapy don′t reach a consensus.Though one meta‑analysis indicated beneficial effect of HAT regimen on decreasing mortality rate of patients with sepsis or septic shock,improving SOFA score and reducing use of vasopressor.However,controversy still exist in the target population,timing,dose and duration of HAT regimen.Thus,the optimized RCTs are needed to provide more definitive evidence.