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Intensive care medicine》2007年3期要目

   《Intensive care medicine》2007年3期这次来的比那本《Critical care medicine》要早，简单的看了一下，觉得有些内容还是可以说说的。

    《Intensive care medicine》（ICM）的文章次序和他的竞争对手《Critical care medicine》(CCM)正好相反，前者是editorial放在最前面，后者则是放在最后。孰优孰劣？个人觉得一样，ICM的社论就那么几篇，因此先看社论就知道哪篇是重点；CCM的社论特别多，几乎要把当期的论著都要评述一遍，这样的话当然放在最后好了。3月号的社论首篇就是ICM的现任主编，法国人Laurent Brochard的退职报告，当了6年的主编，2006年ICM全年发表近1200篇文献，根据文献的质量等多种因素，退稿率在70%左右，作者基本能在6周内得知稿件采用与否，目前杂志的影响因子达到3.724...不容易呀，4月份开始新的主编以及编辑团队就要开始接班了，我们拭目以待。个人看来ICM这几年的发展还是有目共睹的，前几年听人说ICM有着典型的欧洲办事风格，稿件寄出大概要等4-6个月才有回音，现在已经明显改善。此外该杂志刊登的临床研究论著的水平是很高的，近几年更是如此，体现了欧洲危重病的整体临床水平并不比美洲大陆低，尽管某些重大临床研究的最终报告往往没有刊登于该杂志，但是客观地说，很多水平相当高的文献，有些甚至是过了很久才发现其巨大价值的文献可在ICM看到。

    第二篇社论就是我之前反复提及的NIH的“造反派”—— Peter Q. Eichacker和Charles Natanson，两位先后“丧心病狂攻击”ARDS小潮气量和活性蛋白C疗法的资深研究员，这次继最近他们在《New England Journal of Medicine 》发表揭露礼来公司推广活性蛋白C的内幕社论后（Eichacker PQ, Natanson C, Danner RL (2006) Surviving Sepsis: practice guidelines, marketing campaigns, and Eli-Lilly. N Engl J Med 355:1640–1642），又在ICM刊登论调相同的社论，因为这次又有新的证据——来自意大利的多中心研究报告，我们在后面会提及的。社论的题目就是“Increasing evidence that the risks of rhAPC may outweigh its benefits ”（越来越俄多的证据支持rhAPC的弊大于利），看来步把礼来公司的这个摇钱树摇倒不算完，呵呵。难怪最近我看礼来公司在大力推广重组凝血因子Ⅶ和小分子肝素了。社论的最后作者的结论是“Overall, however, our growing experience with rhAPC represents a change in our understanding of the risk-to-benefit ratio of rhAPC. Further randomized controlled trials are necessary to demonstrate whether patients can be prospectively identified that benefit from rhAPC and if such benefit is large enough to warrant the use of rhAPC in clinical practice where the risk of bleeding appears substantial. ”再把作者的几幅有说服力的图示贴上。

Fig. 4 Our understanding of the relative size of the beneficial and adverse effects of rhAPC. This is based on accumulating evidence from controlled trials and clinical surveys starting in 2001 following completion of the PROWESS trial and licensing of rhAPC for clinical use. Since the original beneficial effects of rhAPC have not been confirmed in subsequent trials, but the incidence of bleeding has persisted in trials and increased in clinical use, it is unclear presently whether the benefit of this agent outweighs its risks

社论中还有一个重要的来自澳大利亚、美国和意大利的三位作者关于急性肾衰竭（ARF）定义与分级的特稿，作者提到目前关于ARF大约有30余个定义标准，因此有必要对急性肾功能衰竭的定义取得共识。根据 the Acute Dialysis Quality Initiative (ADQI) 专家组的意见，对ARF的定义可以根据“RIFLE”进行分级和定义，字头的意思是风险(R), 损伤(I),衰竭(F), 持续的肾功丧失(L) 以及终末状态 (E)。这有点像最近SEPSIS的PIEO分级。相信这个“来复枪”标准会得到普及的。

Fig. 1 Graphic summary of the RIFLE criteria (reprinted with permission from Critical Care). Screat, serum creatinine concentration; UO, urine output; GFR, glomerular filtration rate; ARF, acute renal failure

好了，另一篇重要的文章来了！卖个关子，在另一篇发表了！（就是关于那个“拯救”SEPSIS运动——Surviving Sepsis Campaign与欧洲危重病协会的）。

好了，写到这里，本人有一点写烦了，就不多写了，把认为重要的几篇文章目录放上了：

Use of Drotrecogin alfa (activated) in Italian intensive care units: the results of a nationwide survey .这是意大利的2003-2006年rhAPC应用检测报告，研究发现该药造成某些术后患者得极高死亡率，而且很多患者在进入试验程序后不得不“开标”，再次对rhAPC的临床应用敲了警报。

Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study.本文是芬兰的全国性sepsis研究报道，说明重症sepsis人群发病率0.38/1000人，死亡率低于美国和澳大利亚，治疗方面能够遵照循征指南的并不多。

Is there a safe plateau pressure in ARDS? The right heart only knows.结论是通过超声心动图监测右室功能可作为床边监控ARDS机械通气时气道平台压的工具。

Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS
Authors:Xavier Monnet, Nadia Anguel, David Osman, Olfa Hamzaoui, Christian Richard and Jean-Louis Teboul

Pituitary-adrenal responses to human corticotropin-releasing hormone in critically ill patients
Authors:Ioanna Dimopoulou, Panagiota Alevizopoulou, Urania Dafni, Stylianos Orfanos.....
 
Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure?
Authors:Christophe Ridel, David Osman, Lucile Mercadal, Nadia Anguel, Thierry Petitclerc, Christian Richard and Christophe Vinsonneau

Infectious complications of percutaneous central venous catheterization in pediatric patients. A Spanish multicenter study
Authors:M. Ángeles García-Teresa, Juan Casado-Flores, M. Ángel Delgado Domínguez, Jorge Roqueta-Mas, Francisco Cambra-Lasaosa, Andrés Concha-Torre and Cristina Fernández-Pérez
 
Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children
Authors:Corsino Rey, Marta Los Arcos, Andrés Concha, Alberto Medina, Soledad Prieto, Pablo Martinez and Belen Prieto
 
Effects of levosimendan (左西孟旦<强心药>)and dobutamine in experimental acute endotoxemia: a preliminary controlled study
Authors:Arnaldo Dubin, Gastón Murias, Juan Pablo Sottile, Mario Omar Pozo, Marcelo Barán, Vanina Siham Kanoore Edul, Héctor Saúl Canales, Graciela Etcheverry, Bernardo Maskin and Elisa Estenssoro
 
Myocardial lactate deprivation is associated with decreased cardiovascular performance, decreased myocardial energetics, and early death in endotoxic shock
Authors:Bruno Levy, Arnauld Mansart, Chantal Montemont, Sebastien Gibot, Jean-Pierre Mallie, Veronique Regnault, Thomas Lecompte and Patrick Lacolley 
 
Inhaled nitric oxide increases endothelial permeability in Pseudomonas aeruginosa pneumonia .
Authors:Florence Ader, Rozenn Le Berre, Steve Lancel, Karine Faure, Nathalie B. Viget, Emmanuel Nowak, Rémi Nevière and Benoit P. Guery
 
The effect of melatonin(退黑激素)on endotoxemia-induced intestinal apoptosis and oxidative stress in infant rats
Authors:Durgul Ozdemir, Nazan Uysal, Kazim Tugyan, Sevil Gonenc, Osman Acikgoz, Ilkay Aksu and Hasan Ozkan 

Evaluating the use of Drotrecogin alfa (activated) in adult severe sepsis: a Canadian multicenter observational study .这篇文章的结论也不乐观。
Authors:Salmaan Kanji, Marc M. Perreault, Clarence Chant, David Williamson and Lisa Burry

Intensive care outcome of adult patients operated on for congenital heart disease
Authors: Luc Jacquet, Olivier Vancaenegem, Jean Rubay, Fatima Laarbaui, Céline Goffinet, Robin Lovat, Philippe Noirhomme and Gebrine El Khoury

Dose-related effects of direct hemoperfusion using a cytokine adsorbent column for the treatment of experimental endotoxemia
Authors:Takumi Taniguchi, Akihide Kurita, Chisui Mukawa, Ken Yamamoto and Hideo Inaba

Vascular erosion by central venous catheters used for total parenteral nutrition
Authors: Criona Walshe, Dermot Phelan, Jane Bourke and Donal Buggy

Effect of ornithine α-ketoglutarate(鸟氨酸α-酮戊二酸) on glutamine pools in burn injury: evidence of component interaction
Authors: L. Cynober, E. Lasnier, J. Le Boucher, A. Jardel and C. Coudray-Lucas

Complete recovery from an unusual cause of coma
 
Comment on Varpula et al.: Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock
 
Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock: reply to Dr. Bourdeaux

Shock during heparin-induced thrombocytopenia: Look for adrenal insufficiency!

Euthanasia: a word no longer to be used or abused
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