Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynamics and inflammatory response
Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynamics and inflammatory response
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DOI：
10.1007/s00134-003-2087-2
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发表时间：
2004-03-01
影响因子：
38.9
通讯作者：
Romand, JA
中科院分区：
文献类型：
--
作者：
Gozzoli, V;Treggiari, MM;Romand, JA
目的：我们研究了旨在降低发热危重患者体温的药物和物理疗法的代谢、血流动力学和炎症反应。设计和设置：在一所三级大学医院的外科 ICU 中进行开放标签、随机试验。患者：30 名体温为 38.5°C 或更高的镇静机械通气患者被随机分配接受静脉注射安乃近、静脉注射丙帕他莫或外部冷却。测量和结果：在基线和接下来的 4 小时内记录体温、代谢和血流动力学变量。在退热开始前以及退热后 4 小时和 12 小时评估细胞因子浓度。所有治疗组的体温均显着下降。温度每降低 1 摄氏度，外部冷却时能量消耗指数增加 5%，安乃近和丙乙酰氨基酚组分别减少 7% 和 8%。与基线和其他两组相比，安乃近导致平均动脉压和尿量显着降低。 C反应蛋白随着时间的推移而增加，但与其他组相比，接受安乃近的患者在4小时后显着降低。尽管安乃近组的白细胞介素 6 随时间推移呈下降趋势，但三组之间或随时间推移细胞因子浓度没有差异。结论：安乃近、丙乙酰氨基酚和外部冷却同样能降低温度。考虑到不良的血流动力学影响，安乃近不应被视为不稳定患者的首选退热药。应首选丙帕他莫或外部冷却，但对于不太可能耐受外部冷却引起的代谢需求增加的患者应避免使用后者。
Objective: We investigated the metabolic, hemodynamic, and inflammatory responses of pharmacological and physical therapies aimed at reducing body temperature in febrile critically ill patients. Design and setting: Open-label, randomized trial in a surgical ICU in a tertiary university hospital. Patients: Thirty analgosedated, mechanically ventilated patients with a temperature of 38.5degreesC or higher were randomized to receive either intravenous metamizol, intravenous propacetamol, or external cooling. Measurements and results: Body temperature and metabolic and hemodynamic variables were recorded at baseline and during the following 4 h. Cytokine concentrations were assessed before and 4 and 12 h after the initiation of antipyresis. Body temperature decreased significantly in all treatment groups. For a 1degreesC temperature decrease, the energy expenditure index increased by 5% with external cooling and decreased by 7% and 8% in the metamizol and propacetamol groups, respectively. Metamizol induced a significant decrease in mean arterial pressure and urine output compared to baseline and to the other two groups. C-reactive protein increased over time, but compared to the other groups it was significantly lower in patients receiving metamizol after 4 h. Cytokine concentrations were not different among the three groups or over time, although interleukin 6 tended to decrease over time in the metamizol group. Conclusions: Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.