1、脓毒症 的 HAT疗法西部战区总医院干部西部战区总医院干部 ICUCHEST 2017; 151(6):1229-1238Baseline Characteristics of Treated and Control PatientsPaul E. MarikICU Treatment ProtocolOutcome and Treatment VariablesTreated1.Vitamin C 1.5 g, q6h for 4 days or until ICU discharge; (3060min infusion)2.Hydrocortisone50 mg, q6h for 7 d
2、ays or until ICU discharge followed by a taper over 3 days;3.Thiamine200 mg,q12h for 4 days or until ICU discharge (30-min infusion)ControlHydrocortisone50 mg, q6h for 7 days or until ICU discharge followed by a taper over 3 days;结论：早期静脉注射维生素 C，配合使用皮质类固醇和硫胺素可有效预防进行性器官功能障碍，降低严重脓毒症和脓毒症 休克 患者的死亡率，需要进一步
3、的研究来证实这些初步结果。 The Changing Paradigm of Sepsis: Early Diagnosis, Early Antibiotics, Early Pressors,and Early Adjuvant TreatmentCritical Care Medicine.2018 Vitamin C for the treatment of Sepsis: The Scientific RationalePharmacology & therapeutics.2018 Adjuvant Vitamin C in critically ill patients unde
4、rgoing renal replacement therapy: Whats the right dose?Critical Care.2018 Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic AcidNutrients.2018 Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to
5、 Prevent these DeathsSurgical Infections.2018Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic AcidHAT therapy Hydrocortisone Ascorbic Acid Thiamine Nutrients 2018, 10, 1762-75HAT attenuates both the pro- andanti-inflammatoryNutrients 2018, 10, 1
6、762-75HAT therapyParadigm change in the management of sepsis and septic shockCritical Care Medicine.2018HAT therapy争议 &质疑 Vitamin C Is Not Ready for Prime Time in Sepsis but a Solution Is Close Chest.2017.676研究设计问题，非盲法、随机对照、病例数少（ 47），基线不一致性 Vitamin C in Sepsis When It Seems Too Sweet, It Might (Lite
7、rally) Be Chest.2017.450POC监测结果误差较大，存在低血糖风险 Hydrocortisone, Vitamin C and Thiamine for Sepsis， Whither the Ethics in Research?Chest.2017.690伦理学问题、公众宣传、患者安全性 Vitamin C and Sepsis， Framing the Postpublication Discussion Chest.2017.904质疑单中心回顾性研究的价值；谷胱甘肽与 VitC类似。赞同声音 The Unsung Hero Role of Thiamine in the Vitamin C Cocktail Chest.2017.678 研究结果令人兴奋，鸡尾酒疗法中硫胺素功不可没。l 维生素 C代谢过程产生草酸盐，可能在肾脏形成草酸盐结晶。l 硫胺素是促进乙醛酸氧化（乙醛的代谢产物）的辅酶，可促使乙醛酸氧化为 CO2，减少草酸生成。l 基于生理推理，添加硫胺素可降低这种风险。
