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題 名 | 從肺動脈導管到活化蛋白C看重症醫學的過去、現在及未來=From PAC to APC: The Past, Present and Future of Critical Care Medicine |
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作 者 | 黃琬瑜; 王秀鈴; 王義明; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 13:1 2012.03[民101.03] |
頁 次 | 頁19-29 |
分類號 | 415.41 |
關鍵詞 | 肺動脈導管; 活化蛋白C; 重症醫學; 加護病房; Pulmonary artery catheter; Activated protein C; Critical care medicine; Intensive care unit; |
語 文 | 中文(Chinese) |
中文摘要 | 1956年被諾貝爾醫學獎肯定的肺動脈導管,未經人體試驗,在 1970年後就因為能提供關於急性心肌梗塞併發症、休克的病生理學及心血管藥物使用後的藥理反應等資訊,加上學習難度不高、可於病房置放而迅速崛起,成為重症病患血流動力常規性的監測工具。十數年後大型觀察報告及隨機對照研究發現,常規性的置放肺動脈導管,與併發症甚至是死亡有關,肺動脈導管因而風光不再。 到了二十一世初,由於感染引發的全身性發炎反應症候群的致病機轉,由免疫細胞的防禦機制延伸到凝血系統的調控失衡,改變了瀰漫性血管內血凝症的傳統概念,有實証依據、顯著藥效的第一線敗血症治療藥物“活化蛋白 C”終於登場。十年間,活化蛋白 C屢屢被質疑其療效與嚴重出血的安全問題, 2011年年底,因 PROWESS-SHOCK trial結果無法達到預期的藥效,而響起熄燈號。回顧肺動脈導管到活化蛋白 C的過去與現在,重症醫學的未來會往哪裡去? |
英文摘要 | Pulmonary artery catheter (PAC) won the Nobel Prize in Medicine in 1956. It was further developed, and in 1970, the PAC was introduced into clinical practice. Even without human trials, PAC increased in popularity and became widely used because insertion was easily done, it made quantitative hemodynamic data readily available, and could be done at bedside. Thereafter, PAC was used routinely to monitor critically ill patients, which led to challenges, more than a decade later, by association with complications and even death by large observational reports and randomized controlled studies. Routine PAC placement then began to be questioned. In the early twenty-first century, Activated Protein C (APC), so-called “the only cure for sepsis,” was made available due to changing ideas regarding the pathogenesis of systemic inflammatory response syndrome--including not only the immune system but also the coagulation system. The efficacy and safety of APC has repeatedly been questioned during this decade. In late 2011, APC was withdrawn from the worldwide market following the failure of the PROWESS-SHOCK trial to demonstrate efficacy. From PAC to APC, what is the future of critical care medicine? |
本系統中英文摘要資訊取自各篇刊載內容。