大剂量静脉注射维生素C在危重症中的应用
Application of high dose intravenous vitamin C in critical cared diseases
Received date: 2023-07-28
Online published: 2024-01-04
维生素C是人类所必需的一种微量营养素。过去认为，维生素C缺乏可导致坏血病，而近年来大剂量静脉注射维生素C（high dose intravenous vitamin C, HDIVC）作为一种新的治疗手段在危重症领域受到广泛关注。本文从研究历史、应用合理性、研究争议和前景、存在问题和展望对HDIVC在脓毒症等危重症的应用进展进行综述。HDIVC在危重症中的应用大致经历了三个时期，即前期、预热期和爆发期。其应用合理性在于，危重症时人体中维生素C的水平降低，需经静脉迅速补充。笔者分别证实了HDIVC在新型冠状病毒肺炎（新冠肺炎）和重症急性胰腺炎中的治疗效果。HDIVC有抑制炎症反应、稳定循环和增强免疫的作用机制。但目前，HDIVC在危重症中的应用尚存争议。多项大规模随机对照试验存在相反的研究结果。今后的研究可能要在维生素C应用剂量和时间及浓度监测等方面进一步关注。
关键词： 维生素C; 大剂量静脉注射维生素C; 危重症
赵冰, 虞纤纤, 毛恩强 . 大剂量静脉注射维生素C在危重症中的应用[J]. 外科理论与实践, 2023 , 28(05) : 437 -440 . DOI: 10.16139/j.1007-9610.2023.05.08
Vitamin C is an essential micronutrient for human and its deficiency will lead to scurvy. In recent years, as a new therapeutic strategy, high dose intravenous vitamin C(HDIVC) has been widely studied in critical cared diseases. In this review, we summarized the progress of HDIVC in sepsis, including its research history, rationality of usage, controversy and prospect, problems and outlook. The application of HDIVC in critical cared diseases underwent three periods: early, preheating and outbreaking period. Given the reduction of vitamin C in critical diseases, it requires rapid intravenous supplementation. We confirmed the therapeutic efficacy of HDIVC in COVID-19 and severe acute pancreatitis respectively. It is well known that HDIVC has effect of suppressing inflammatory responses, stabilizing the circulation and improving the immunity. But the application of HDIVC in critical cared diseases is still controversial, for the opposing findings in multiple large-scale randomized controlled trials. Future studies should be better to pay further attention on the dose and time of vitamin C and vitamin C plasma concentration monitoring.
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