Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre,randomised, double-blinded trial

Purpose

Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin’s effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock.

Methods

In this multicentre, randomised, double-blinded trial, patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4 mg/day) or NE (4–30 µg/min) before open-label vasopressors. The primary endpoint was mortality 28 days after the start of infusion. Primary efficacy endpoint analysis and safety analysis were performed on the data from a modified intention-to-treat population.

Results

Between 1 January 2013 and 28 February 2016, 617 patients were randomised (312 to the terlipressin group, 305 to the NE group). The modified intention-to-treat population comprised 526 (85.3%) patients (260 in the terlipressin group and 266 in the NE group). There was no significant difference in 28-day mortality rate between the terlipressin group (40%) and the NE group (38%) (odds ratio 0.93 [95% CI 0.55–1.56]; p?=?0.80). Change in SOFA score on day 7 was similar between the two groups: ??7 (IQR ??11 to 3) in the terlipressin group and ??6 (IQR ??10 to 5) in the NE group. There was no difference between the groups in the number of days alive and free of vasopressors. Overall, serious adverse events were more common in the terlipressin group than in the NE group (30% vs 12%; p?<?0.001).

Conclusions

In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.

Trial registration

This trial is registered at ClinicalTrials.gov: ID NCT01697410.

     

镍钛记忆合金环抱器治疗多发性肋骨骨折的临床研究

目的：探讨镍钛记忆合金环抱器治疗多发性肋骨骨折的疗效。方法100例多发性肋骨骨折患者均采用镍钛记忆合金环抱器行手术治疗。结果患者均无感染,骨折不愈合及内固定松动、滑脱等并发症发生;术后5个月~12个月取出内固定,骨折部位无炎症反应,心肺功能恢复较好。结论镍钛记忆合金环抱器呈现出良好的组织相容性,手术操作简便、创伤小、并发症少,是一种较为理想的治疗多发性肋骨骨折的方法。     

Diagnostic Accuracy of Bronchodilator Response for Asthma in a Population of South China

Introduction

A significant bronchodilator response is commonly defined as a 12% or greater and 200 ml or greater change in FEV₁ from baseline according to the 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) criterion. A number of studies have shown that the ATS/ERS criterion has limitations in asthma diagnosis, and some experts have argued for correcting the criteria. The aim of this study is to investigate the diagnostic value of acute bronchodilator response for asthma in a Southern Chinese population.

Methods

We prospectively evaluated 805 patients with obstructive lung disease (309 for asthma, 496 for non-asthma). Spirometry was performed according to the ATS/ERS guidelines. Data were analyzed by SPSS 18.0. The receiver-operating characteristic (ROC) curve was drawn to assess the diagnostic accuracy of the ATS/ERS criterion based on FEV₁. Linear regression was used to analyze the factors of FEV₁ change.

Results

The sensitivity and specificity of the acute bronchodilator test when judged by the ATS/ERS criteria (200 ml or higher and 12% improvement) were 68.6% and 78.2%, respectively. For the ATS/ERS criteria, the Youden Index, which comprehensively reflects the authenticity of a diagnostic test, was 46.8%. The absolute change of FEV₁ positively correlated with baseline FEV₁ and weight and negatively with age, while the percentage change of FEV₁ was negatively correlated with baseline FEV₁, age and height and positively with weight. Compared with the different diagnostic values, when ?FEV₁ was 195 ml and ?FEV_1i% was 14%, the Youden Index was the largest (48.2%) and the diagnostic capability of the test the biggest.

Conclusions

The ATS/ERS criterion for acute bronchodilator response might not be completely suitable for asthma in the Chinese population.

Trial Registration

Chinese Clinical Trial Registry (Registry ID: ChiCTR-DDT-14004976).

Funding

This work was supported by the National Natural Science Foundation of China (grant nos. 81670027, 81270080).

     

严重粘连性小瞳孔的白内障超声乳化术

目的探讨严重粘连性小瞳孔白内障超声乳化术的安全性及手术技巧。方法对26例(32只眼)粘连性小瞳孔白内障,术中采用透明角膜切口,散瞳后瞳孔直径(2.5±0.5)mm。以晶状体调位钩及chopper钩辅助,松解粘连,扩大瞳孔至4~5 mm,连续环形撕囊后进行原位白内障超声乳化吸除及折叠人工晶状体植入。结果术后3个月随访,术眼视力均较术前提高,其中视力≥0.5者20只眼(62.5%)。术后患眼瞳孔接近圆形或椭圆形,部分患者瞳孔直径较术前偏大。但其中2只眼再发部分后粘连,1只眼后囊少许破裂,仍植入人工晶状体,无人工晶状体明显偏位。结论采用上述技术不仅顺利完成小瞳孔白内障超声乳化术,且手术安全有效,视力恢复较好,保持或接近生理性圆,手术并发症相对减少。     

鼠神经生长因子对外伤性视神经病变治疗作用的Meta分析

目的：系统评价鼠神经生长因子治疗外伤性视神经病变的临床效果。
　　方法：计算机检索 Cochrane Library、Pubmed、Medline、中国数字医院图书馆(www. chkd. cnki. net)全文数据库、万方数据库、中文科技期刊全文数据库( VIP),检索时间为建库至2014-01,并辅以手工检索,全面收集有关鼠神经生长因子治疗外伤性视神经病变的对照研究,评价纳入研究质量,提取有效数据,并进行Meta分析。
　　结果：符合纳入标准的对照试验文献7篇,合计399眼,鼠神经生长因子参与治疗后,优势比OR=3.78,95%CI为[2.35,6.06],P<0.01,差异具有统计学意义。
　　结论：从现有的临床证据来看,鼠神经生长因子参与治疗能提高外伤性视神经病变的治疗有效率。但还需要更多高质量的多中心、随机、双盲临床试验来进一步验证和支持。     

盐酸环喷托酯滴眼液在儿童屈光状态检查中的应用

目的：探讨10 g/L盐酸环喷托酯滴眼液在小儿屈光状态检查中的应用。比较其与阿托品在散瞳验光中麻痹睫状肌的效果,用以指导临床工作。
　　方法：采用自身配对设计方法,对年龄3~12岁118例236眼(其中近视40例80眼,远视78例156眼,合并有散光73例146眼)先采用10 g/L盐酸环喷托酯滴眼液滴眼3次散瞳(每次间隔5min),末次点眼1h后进行检影验光。间隔3d后重新点10g/L阿托品眼膏1wk(每晚1次)重新进行散瞳检影验光。按屈光度分成近视组、远视组、散光组,其中散光度数是将柱镜度数独立分离出来统计。将两种散瞳药的验光结果进行比较。
　　结果：近视组使用两种方法散瞳验光后屈光度值分别为-2.25±1.31D,-2.23±1.32D,差异无统计学意义( P=0.109);远视组应用两种药物散瞳验光后屈光度分别为3.76±2.4D,4.39±2.6D,差异有统计学意义(P=0.000);散光组应用两种药物散瞳验光后屈光度值分别为1.35±1.19D,1.38±2.00D,差异无统计学意义(P=0.374)。
　　结论：盐酸环喷托酯滴眼液可用于临床上3~12岁近视、散光儿童的散瞳验光。但在远视儿童初次就诊仍需点阿托品眼膏散瞳验光。     

半导体激光经巩膜睫状体光凝术治疗难治性青光眼

目的：评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的临床疗效和安全性。
　　方法：回顾性分析2012－03／2013－03到我院眼科就诊33例33眼难治性青光眼患者临床资料,所有患者均行半导体激光经巩膜睫状体光凝术,激光能量1000～3000 mW,时间2000～3000ms,击射范围270°～360°,击射点20～40点。随访观察并记录患者临床症状、视力、眼压、眼前节及并发症,随访时间为6 mo。
　　结果：最后随访时32例（97％）的患者眼部症状明显缓解或消失;术前平均眼压为50．26±9．37mmHg,最后随访6mo时平均眼压下降为18．38±8．73mmHg,治疗前后眼压具有统计学意义（P＜0．05）。2例（6％）术后3mo时眼压再次升高,给予再次激光治疗,术后并发症为前房炎症反应9例（27％）,前房出血5例（15％）,结膜下出血2例（6％）,结膜充血水肿12例（36％）,眼球萎缩1例（3％）。结论：半导体激光经巩膜睫状体光凝术治疗难治性青光眼是一种简便、降压显著、痛苦小、安全有效的方法。     

更昔洛韦眼用凝胶和阿昔洛韦滴眼液治疗病毒性角膜炎疗效对比

目的：探讨病毒性角膜炎应用更昔洛韦眼用凝胶的疗效。

方法：随机选择2013-05/2014-10我院收治的84例101眼病毒性角膜炎患者作为研究对象,随机分为更昔洛韦组和对照组,分别给予更昔洛韦眼用凝胶和阿昔洛韦滴眼液治疗,2wk后观察疗效。

结果：两组患者治疗后较治疗前病毒性角膜炎各症状(畏光、流泪、疼痛、异物感)及各体征(睫状充血、角膜上皮缺损、角膜基质水肿、角膜荧光素染色)评分均有显著改善,更昔洛韦组改善更为明显(P<0.05); 更昔洛韦组有效率(92.9%)明显高于对照组(59.5%),差异有统计学意义(P<0.05); 两组患者不良反应无统计学差异(P>0.05),更昔洛韦组复发率明显低于对照组(P<0.05)。

结论：更昔洛韦眼用凝胶是一种安全有效的抗病毒滴眼液,治疗病毒性角膜炎疗效确切,值得临床中推广应用。