感染性休克使用特利加压素还是去甲肾上腺素？
Teripressin Is Used in Septic Shock Still Norepinephrine?
DOI: 10.12677/acm.2025.152314, PDF, HTML, XML,    科研立项经费支持
作者: 刘 澳：内蒙古医科大学包头临床医学院，内蒙古 包头；王君艳*：包头市中心医院重症医学科，内蒙古 包头
关键词: 特利加压素；去甲肾上腺素；感染性休克；联合治疗；Teripressin； Norepinephrine； Septic Shock； Combination Therapy
摘要: 背景：全球脓毒症休克的发病率和死亡率居高不下，尽管去甲肾上腺素可以增加危重病人的血压，但对额外治疗的需求未得到满足。方法：特利加压素与去甲肾上腺素治疗感染性休克的多中心随机对照试验来解决这个问题。结果：将617例患者随机分配到特利加压素(n = 312)或去甲肾上腺素输注(n = 305)联合标准治疗组，其中包括开放标签血管加压药。对主要终点，即亚组28天死亡率(特利加压素n = 260；去甲肾上腺素n = 266)进行了先验改良的意向治疗初步分析。28天死亡率无差异(特利加压素 = 40%，去甲肾上腺素 = 38%，p NS)。选定的次要终点，如存活天数和无血管加压药天数以及脓毒症器官衰竭评估(SOFA)评分的变化，组间没有差异。然而，特利加压素组的不良事件比去甲肾上腺素组更严重(30% vs. 12%, P < 0.01)。结论：特利加压素和去甲肾上腺素之间的死亡率没有差异，但特利加压素有更严重的不良事件。因此，去甲肾上腺素仍然是首选的血管加压药，但对于对去甲肾上腺素无反应的难治性脓毒性休克患者，可以加用加压素或特利加压素。
Abstract: Background: The incidence and mortality of septic shock remain high globally, and although norepinephrine can increase blood pressure in critically ill patients, there is an unmet need for additional treatment. Methods: A multicenter randomized controlled trial of teripressin versus norepinephrine for septic shock was conducted to address this issue. Results: 617 patients were randomly assigned to teripressin (n = 312) or norepinephrine infusion (n = 305) in combination with standard care, which included open-label vasopressors. For the primary endpoint, the subgroup 28-day mortality (teripressin n = 260; Norepinephrine n = 266) performed a preliminary analysis of intention-to-treat with a priori modification. There was no difference in mortality at 28 days (teripressin = 40%, norepinephrine = 38%, pNS). Selected secondary endpoints, such as days of survival and vasopressor free days and changes in the Sepsis Organ Failure Assessment (SOFA) score, did not differ between groups. However, adverse events were more severe in the teripressin group than in the norepinephrine group (30% vs. 12%, P < 0.01). Conclusions: There was no difference in mortality between teripressin and norepinephrine, but teripressin had more serious adverse events. Therefore, norepinephrine remains the vasopressor of choice, but for patients with refractory septic shock who do not respond to norepinephrine, vasopressin or teripressin may be added.
文章引用：刘澳, 王君艳. 感染性休克使用特利加压素还是去甲肾上腺素？[J]. 临床医学进展, 2025, 15(2): 50-54. https://doi.org/10.12677/acm.2025.152314

基金项目

内蒙古医学科学院公立医院科研联合基金项目。

NOTES

*通讯作者。

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